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2 PROPOSED OFFICERS, STOCK OR OWNERSHIP INTEREST(Continued...j <br /> List all proposed individuals or entities that will have a direct or indirect,beneficial or financial interest in this license(E.g.Stockholders, <br /> Officers,Directors,LLC Managers,LLP Partners,Trustees etc.). <br /> Entity Name Percentage of Ownership in Entity being Licensed <br /> �Mashpee Oriental, Inc. (Write"NA"if this is the entity being licensed) <br /> N/A <br /> Name of Principal Residential Address SSN DOB <br /> Sipaiu Hong <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> Shareholder 1 15 shares (`Yes f: No I (::Yes ( No C:;Yes (, No <br /> Name of Principal Residential Address SSN DOB <br /> F— <br /> Chao Chun Lin <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> (:Yes {.:No ( :Yes C: No (::Yes C No <br /> Shareholder 13.333 shares I �.� �� <br /> Name of Principal Residential Address----- ��� SSN DOB <br /> Fichelle F. Shepard <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> [Shareholder 5 shares Yes (:;No (:.Yes (';No (:i Yes (i No <br /> Name of Principal Residential Address SSN DOB <br /> [Fang Yan Ren <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> [Shareholder :::] 10 shares (`Yes {: No ( Yes :No (: Yes (^,No <br /> Name of Principal Residential Address SSN_ DOB <br /> ly—ouxiang Wang —� F <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> Shareholder 10 shares r;Yes {: No C`Yes (;.No {: Yes C No <br /> Name of Principal Residential Address SSN DOB. <br /> F- I F <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> Yes (_N� (':Yes C No� ('.Yes (` No <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> F7C'.Yes (' No ( YesYes (':No <br /> CRIMINAL HISTORY <br /> Has any individual identified above ever been convicted of a State,Federal or Military Crime? (` Yes (: No <br /> If yes,attach an affidavit providing the details of any and all convictions. <br />