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The Commonwealth of Massachusetts <br /> Alcoholic Beverages Control Commission <br /> 95 Fourth Street,Suite 3, Chelsea,JM 02150-2358 <br /> w <br /> www.mass.gov a cc <br /> APPLICATION FOR AMENDMENT <br /> -Change of officers Stock or Ownership Interest <br /> p Change of officers/ Directors/LLC Managers p Change of Stock Interest <br /> • DOR Certificate of Good Standing (e.g.New Stockholders or Transfer or Issuance of Stock) <br /> • DUA Certificate of Compliance • D Certificate of Good Standing <br /> OR C g <br /> • Change of officer/Directors Application • DUA Certificate of Compliance <br /> • CORI Authorization • Change of Stock.A lication <br /> • Vote of the Entity g lap <br /> • CORI Authorization <br /> ® Payment Receipt • Financial Statement <br /> • Advertisement • Vote of the Entity <br /> • Business Structure Documents <br /> Business Certificate • Purchase&Sale Agreement <br /> • <br /> If Sole Proprietor, <br /> • if partnership,PartnershipAgreement • Supporting Financial Records <br /> p p' g • Advertisement <br /> • If corporation or LLC,Articles of Organization , Payment Receipt <br /> from the Secretary of the Commonwealth y p <br /> • Business Structure Documents <br /> • if Sole Proprietor,Business Certificate <br /> EjChange of Ownership Interest • If partnership, Partnership Agreement <br /> (e.g.LLC Members,LLP Partners,Trustees etc.) • If corporation or LLC,Articles of organization <br /> • DOR Certificate of Good Standin g from the Secretary of the Commonwealth <br /> ■ DUA Certificate of Compliance Nonawpro It Club Change of officers/ Directors <br /> • Change of Stock Application . DOR Certificate of Good Standing <br /> ■ CORI Authorization . <br /> • DUA Certificate of Compliance <br /> . Financial Statement • of officer Chan e Directors Application <br /> • Vote of the Entity • Vote of the club signed by an approved officer <br /> • Purchase&Sale Agreement . payment Receipt <br /> • Supporting Financial Records <br /> ■ Business Structure Documents-Articles of <br /> • Advertisement <br /> Organization from the Secretary of the Commonwealth <br /> • Payment Receipt <br /> ■ Business Structure Documents Management Agreement <br /> • If Sole Proprietor, Business Certificate f • DOR Certificate of Good Standing <br /> • If partnership,Partnership Agreement ■ DUA Certificate of Compliance <br /> • If corporation or LLC,Articles of organization ■ Management Agreement <br /> from the Secretary of the Commonwealth • Vote of Entity <br /> ■ Payment Receipt <br /> *If abutter notification and advertisement are required for transaction,please see the focal licensing authority. <br /> 1. BUSINESS ENTITY INFORMATION <br /> Entity Name Municipality ABCC License Number <br /> Darbys Natural Markets LLC Town Of Mashpee PS11 M-19-0020 <br /> Please provide a narrative overview of the transaction(s)being applied for.Attach additional pages,if necessary. <br /> Change of Ownership interest from Mother and Father to Daughter and son in law. <br /> APPLICATION CONTACT <br /> The application contact is the person who should be contacted with any questions regarding this application. <br /> Name Title Email Phone <br /> Rory Eames CEO <br /> L. f _ <br /> 1 <br />