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The Commonwealth of Massachusetts <br /> Alcoholic.beverages Control Commission <br /> 95.Fourth,Street, Suite 3, Chelsea,MA 02.150-2358 <br /> y www.mass,govlabcc <br /> APPLICATION FOR AMENDMENT-Change of Business Entity Information <br /> ❑ Change of Corporate Name D Change of Corporate Structure <br /> Fx� Change of DBA • DOR Certificate of Good Standing <br /> • DUA Certificate of Compliance <br /> • DOR Certificate of Good Standing(Req.for Chg of Corp • Change of Corporate Structure Application <br /> Name only) g p <br /> • DUA Certificate of Compliance (Req.for Chg of Corp <br /> • Vote of the Entity <br /> • Payment Receipt <br /> Name only) <br /> * Business Structure cture Documents <br /> • Change of Corporate Name DBA Application <br /> • Vote of the Entity ® If Sole Proprietor,Business Certificate <br /> • Pa meet Receipt ® If partnership, Partnership Agreement <br /> y p ® If corporation or LLC,Articles of Organization <br /> ® Business Structure Documents p g <br /> • If Sole Proprietor,Business Certificate from the Secretary of the Commonwealth <br /> • If partnership, Partnership Agreement <br /> • If corporation or LLC,.Articles of organization <br /> from the Secretary of the Commonwealth <br /> 1. BUSINESS ENTITY INFORMATION <br /> Entity Name Municipality ABCC License Number <br /> Darby's Natural Markets LLC Town of Mashpee PSWM-19-0020 <br /> Please provide a narrative overview of the transaction(s)being applied for. <br /> change of DBA on wine&beer license <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/Manager <br /> 2 . CHANGES TO BUSINESS ENITIY INFORMATION <br /> Last-Approved Corporate Name.- <br /> 2a. <br /> ame:2a.Change of Corporate Name <br /> Requested New Corporate Name: <br /> Last-Approved DBA: Organic Market <br /> 2b.Change of DBA <br /> Requested New DBA: Rory's <br /> c.Chancie of Corporate Structure Last-Approved Corporate Structure <br /> LLC,Corporation,Sole Proprietor,etc <br /> Requested N ew.Corpo rate Structure <br /> Digitally signed by Rory Eames 13,2019 <br /> Sig nature:Rory Eames May y Date:2019.05,1 3 12:41:21-04'00' <br /> Title: CEO/Manager <br />