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The Commonwealth of Massachusetts <br /> Alcoholic Beverages Control Commission <br /> 95.fourth Street,Suite 3, Chelsea,MA 02150-2358 <br /> www.mass.gov/ahcc <br /> r <br /> RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION <br /> MONETARY TRANSMITTAL FORM <br /> APPLICATION FOR AMENDMENT-Chan a of Business Entit information <br /> APPLICATION SHOULD BE COMPLETED ON-LINE, PRINTED,SIGNED,AND SUBMITTED TO THE LOCAL <br /> LICENSING AUTHORITY. <br /> ECRT CODE: RETA <br /> Please mare$200.00 payment here: ABCC PAYMENT WEBSITE <br /> PAYMENT MUST DENOTE THE NAME OF THE LICENSEE CORPORATION,LLC, PARTNERSHIP,OR INDIVIDUAL AND INCLUDE THE <br /> PAYMENT RECEIPT <br /> ABCC LICENSE NUMBER(IF AN EXISTING LICENSEE,CAN BE OBTAINED FROM THE CITY) PSWM-19--0020 <br /> ENTITY/LICENSEE NAME Da rhy's Natural Markets LLC <br /> ADDRESS 32 Market Street <br /> CITY/TOWN Mashpee STATE IMA ZIP CODE 102649 <br /> For the following transactions (Check all that apply): <br /> ❑ New License ❑ Change of Location ❑ Change of Class(1.e.Annual Seasonal} ❑ Change Corporate Structure(i.e.corp 1 LLQ <br /> © Transfer of License ❑ Alteration of Licensed PremisesChange of License Type(i.e.club restaurant) ❑ Pledge of Collateral{i.e.License/Stock) <br /> ❑ Change of Manager ❑ Change Corporate NameChange of Category(i.e.All Alcohol/wine,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 Q (LLC Members/LLP Partners, <br /> Trustees) ElOther ❑ 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 /> 95 Fourth Streets Suite 3 <br /> Chelsea,MA 02150.2355 <br />