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APPLICATION FOR ANEW LICENSE <br /> CORPORATE STRUCTURE <br /> Date of incorporation 04/02/2013 Cor ❑rationintity Legal Structure <br /> State of Incorporation Massachusetts <br /> Is the Corporation publicly traded? Yes x No <br /> 6. PROPOSED OFFICERS STOCK OR OWNERSHIP INTEREST <br /> List all individuals or entities that will have a direct or indirect,beneficial or financial interest in this license(E.g.Stockholders,Officers, <br /> Directors,LLC Managers,LLP Partners,Trustees etc.),Attach additional page(s)provided,if necessary,utilizing Addendum A. <br /> * The individuals and titles listed in this section must be identical to those filed with the Massachusetts Secretary of State. <br /> The individuals identified in this section,as well as the proposed Manager of Recon,must complete a CORI Release Form. <br /> 0 Please note the following statutory requirements for Directors and LLC Managers; <br /> On Premises(E.g.Restaurant/Club/Hotel)Directors or LLC Managers -At least 50%must be-US citizens; <br /> Off Premises(Liquor Store)Directors or LLC Managers All must be US citizens and a majority-must be <br /> Massachusetts residents. <br /> ® If you are a Multi-Tiered Organization,please attach a flow chart identifying each corporate interest and the individual owners of <br /> each entity as well as the Articles of Organization for each corporate entity. Every individual must be identified in Addendum A. <br /> Name of Principal Residential Address SSN DOB <br /> r <br /> Saeed A. Chaudhry <br /> r <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> Owner and Manager 100 Yes No •Yes No Yes .No <br /> Name of Princl-pal Residential Address SSN DOB <br /> Title and or Position Percenta e of Ownershi Director/LLC Manager US Citizen MA Resident <br /> Yes ;=No C)Yes �;N o f Yes �No <br /> Name of-Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> Yes ?No 0,Yes No C Yes (,,.,No <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> Yes �_'N Yes 5 N o 'Yes k N❑ <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> Yes ( .No Yes 3 No `f Yes No <br /> Additional pages attached? 0.Yes No <br /> CRIMINAL HISTORY <br /> Has any individual listed in question 5,and applicable attachments,ever been convicted of a .)Yes No <br /> State,Federal or Military Crime?If yes,attach an affidavit providing the details of any and all convictions. <br /> MANAGEMENT AGREEMENT <br /> Are you requesting approval to utilize a management company through a management agreement? <br /> Please provide a copy of the management agreement. Yes ;=No <br />