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r <br /> The Commonwealth of Massachusetts <br /> Alcoholic Beverages Control Comm"ss ion <br /> 95 Fourth Street,Suite 3, Chelsea,.MA 02150-2358 <br /> M www.mass.govlabcc <br /> RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION n, <br /> MONETARY TRANSMITTAL <br /> FORM <br /> APPLICATION FOR AMENDMENT-Change of Business Entity Information <br /> APPLICATION SHOULD BE COMPLETED DN-LINE, PRINTED,SIGNED,AND SUBMITTED TO THE LOCAL <br /> LICENSING AUTHORITY. <br /> ECRT CODE: RETA <br /> Please make$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-IJ-UDC <br /> ENTITY/LICENSEE NAME Darby's Natural Markets LLC <br /> ADDRESS 32 Market Street <br /> CITY/TOWN Mashpee STATE MA ZIP CODE 02649 <br /> For the following transactions (Check all that apply): <br /> ❑ NeW License ❑ Change of LocationChange of Class(i.e.Annual!Seasonal) ❑ Change Corporate Structure(i.e.Corp/LLQ <br /> © Transfer of License ❑ Alteration of Licensed Premises F-1 Cha nge of License Type(i.e.club l restaurant) E] 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 (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 /> 95 Fourth Street, Suite 3 <br /> Chelsea,MA 02150-2358 <br />