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The Commonwealth of Massachusetts <br /> Alcoholic Beverages Control Commission <br /> 239 Causeway Street Boston,MA 02114 <br /> www.mass.govlabcc nnr iO4P '9 <br /> AJ.-' 02 <br /> RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION <br /> MONETARY TRANSMITTAL FORM <br /> AMENDMENT-Change or Alteration of Premises Information <br /> APPLICATION SHOULD BE COMPLETED ON-LINE, PRINTED,SIGNED,AND SUBMITTED TO THE LOCAL <br /> LICENSING AUTHORITY. <br /> ECRT CODE: RETA <br /> Please make$200.00 payment here:https://www.mass.gov/epay-for-online-payments-abcc <br /> PAYMENT MUST DENOTE THE NAME OF THE LICENSEE CORPORATION,LLC,PARTNERSHIP,OR INDIVIDUAL <br /> SPAY CONFIRMATION NUMBER See attached recq4. <br /> A.B.C.C.LICENSE NUMBER(IF AN EXISTING LICENSEE,CAN BE OBTAINED FROM THE CITY) 1067000003 <br /> ENTITY/LICENSEE NAME lNew Seabury Resources Management, Inc.d/b/a Club at New Seabury <br /> ADDRESS 122 Seanest Drive <br /> CITY/TOWN Imashpee STATE. Mq ZIP CODE 102649 <br /> For the following transactions (Check all that apply): <br /> El New License ❑ Change of Location ❑ Change of Class(i.e.Annual/Seasonal) E] Change Corporate Structure(Le.COTP LLQ <br /> F� Transfer of License Z Alteration of Licensed Premises F] Change of License Type(Le.club/restaurant) 0 Pledge of Collateral(i.e.License/Stock) <br /> ❑ Change of Manager R Change Corporate Name Change of category(!.e.All AlcoholMine,Malt) ❑ Management/Operating Agreement <br /> Change of Officers/ Change of Ownership Interest ❑ Issuance/Transfer of,Stock/New Stockholder ❑ Change of Hours <br /> ❑ Directors/LLC Managers F (LLC Members/LLP Partners, <br /> Trustees) ❑Other Change of DBA <br /> THE LOCAL LICENSING AUTHORITY MUST MAIL THIS <br /> TRANSMITTAL FORM ALONG WITH <br /> COMPLETED APPLICATION, AND SUPPORTING DOCUMENTS TO: <br /> ALCOHOLIC BEVERAGES CONTROL COMMISSION <br /> 239 CAUSEWAY STREET <br /> BOSTON, MA 02241-3396 <br />