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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/abcc <br /> r RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION <br /> MONETARY TRANSMITTAL FORM <br /> APPLICATION FOR A NEW LICENSE <br /> APPLICATION SHOULD BE COMPLETED ON-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) <br /> ENTITY/LICENSEE NAME Commons Convenience,Inc. <br /> ADDRESS 414 Nathan Ellis Highway <br /> CITY/TOWN Mashpee I STATE IMA ZIP CODE 102649 <br /> For the following transactions (Check all that apply): <br /> 0 New License ❑ Change of Location ❑ Change of Class(i.e.Annuals Seasonal)-. E] Change Corporate Structure(i.e.Corp t LLQ <br /> ❑Transfer of License © Alteration of Licensed Premises © Change of License Type(i.e.club/restaurant) F] Pledge of Collateral Re.License/Stock) <br /> Change of Manager © Change Corporate Name ❑ Change of Category(i.e.All Alcohol/Wine,Malt) D 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,NU 02150-2358 <br />