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The Commonwealth of Massachusetts <br /> _ Alcoholic Beverages Control Commission <br /> 95 Fourth Street,Suite 3, Chelsea,MA 02I50-2358 <br /> a , > <br /> www.mass.gov/abcc <br /> Y,r° RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICA�I"IIN"C 18 pit 1 53 <br /> MONETARY TRANSMITTAL FORM <br /> APPLICATION FOR AMENDMENT-Change of Officers, Stock or Ownership Interest <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) 00073-RS-0670 <br /> ENTITY/LICENSEE NAME Mashpee Oriental, Inc. <br /> ADDRESS 3 Greene Street <br /> CITY/TOWN Mashpee STATE MA — ZIP CODE 02649 <br /> For the following transactions (Check all that apply): <br /> ❑ New License ❑ Change of Location ❑ Change of Class(i.e.Annual/Seasonal) ❑ Change Corporate Structure(i.e.Corp/LLQ <br /> ❑ Transfer of License ❑ Alteration of Licensed Premises ❑ Change of License Type(i.e.club/restaurant) ❑ Pledge of Collateral(i.e.License/stock) <br /> ❑ Change of Manager ❑ Change Corporate Name ❑ Change of category(i.e.All Aicohovwine,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 />