03/25/2019 BOARD OF SELECTMEN Agenda Packet

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APPLICANT'S'STATEMENT i i,chr6topher D.card the: ®sole proprietor; Upartner; E corporate principal; ® LLC/'LLP manager Authorized Signatory ofNwuryResources'Management.lnc,' Name of the Entity/Corporation hereby submit'this application(hereinafterthe"Application„),to the local licensing authority(the"LLA”)and the Alcoholic Beverages Control Comrnission:(the"ABCC"and together with the:LLA collectively the"Licensing Authorities")for approval. I do hereby declaro:under the painsand penalties of perjury that]have personal knowledge.of the information submitted in the Application,and as such.affirm that:all statements and:representations therein are true to the best of my knowledge and belief. I further submit the following to be true and accurate: � (1) 1 understand that'each representation ln:this Application is material to the Licensing Authorities'decision on the Application and that the Licensing Authorities will rely.on each and every answer in the Application and accompanying documentsin reaching its;decision; (2) 1 state that the location and description of the proposed licensed premises are in compliance with state and iocal laws and regulations; (3) I understand that while the Application is pending,imust notify the Licensing Authorities of any change in the Information submitted therein, .I understand that failure to:give such notice to the Licensing Authorities may result in disapproval,of.the Application; (4) 1 understand:that upomapproval of the Application,]must notify the Licensing Authorities of any change in the ownership as.approved by the Licensing Authorities. 1 understand that failure to give such notice to the Licensing Authorities may result in sanctions including revocation of any license:for which this Application is submitted; (5) 1 understand that the licensee will.be:bound bythe statements and representations made in the Application,including, but not limited to the identity of persons with an ownership or financial interest,in the license; (6) 1 understand that all statements and representations made become conditions of the license, (7) I understand that any physical:alterations.to or changes to the size of the area used for the sale,delivery,storage,or consumption of alcoholic beverages,must be reported to the Licensing Authorities and may require the prior approval of the Licensing Authorities; (8) 1 understand that the licensee's failure to operate the licensed premises in accordance with the statements and representations made:In.the Application may result in sanctions,including the revocation of any license for which the Application w0s.submitted;;and (9.) 1 understand that any false statement,or,thisrepresentation will constitute cause for disapproval of the Application or sanctions including revocation of:any license for which this.Application is submitted. (10) 1 confirm that the.appllcant corporation and each individual listed in the ownership section of the application is in good.standing with the Massachusetts Department of Revenue.and has compiled with all laws of the Commonwealth relating to taxes;repo tti playee �contractors,and.withfiolding and remitting of child support. Signature: Gate: 7,Vrr ,title: President !