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APPLICANT'S STATEMENT <br /> I MO Na Ko --� the: sole proprietor; F partner; N corporate principal; C LLCALP manager <br /> Authorized Signatory <br /> of I Mashpee Oriental,Inc. i <br /> Name of the Entity/Corporation <br /> hereby submit this application(hereinafter the"Application"),to the local licensing authority(the "LLA")and the Alcoholic <br /> Beverages Control Commission (the"ABCC"and together with the LLA collectively the"Licensing Authorities")for approval. <br /> I do hereby declare under the pains and penalties of perjury that I have personal knowledge of the information submitted in the <br /> Application,and as such affirm that all statements and representations therein are true to the best of my knowledge and belief. <br /> I further submit the following to be true and accurate: <br /> (1) 1 understand that Each representation in this Application is material to the Licensing Authorities'decision on the <br /> Application and that the Licensing Authorities will rely on each and every answer in the Application and accompanying <br /> documents in reaching its decision; <br /> (2) 1 state that the location and description of the proposed licensed premises are in compliance with state <br /> and local laws and regulations; <br /> (3) 1 understand that while the Application is pending,I must notify the Licensing Authorities of any change in the <br /> information submitted therein. I understand that failure to give such notice to the Licensing Authorities may result in <br /> disapproval of the Application; <br /> (4) 1 understand that upon approval of the Application, I must notify the Licensing Authorities of any change in the <br /> ownership as approved by the Licensing Authorities. I understand that failure to give such notice to the <br /> Licensing Authorities may result in sanctions including revocation of any license for which this Application is submitted; <br /> (5) 1 understand that the licensee will be bound by the statements and representations made in the Application, including, <br /> but not limited to the identity of persons with an ownership or financial interest in the license; <br /> (6) 1 understand that all statements and representations made become conditions of the license; <br /> (7) 1 understand that any physical alterations to or changes to the size of the area used for the sale,delivery,storage, or <br /> consumption of alcoholic beverages, must be reported to the Licensing Authorities and may require the prior approval <br /> of the Licensing Authorities; <br /> (8) 1 understand that the licensee's failure to operate the licensed premises in accordance with the statements and <br /> representations made in the Application may result in sanctions,including the revocation of any license for which the <br /> Application was submitted;and <br /> (9) 1 understand that any false statement or misrepresentation will constitute cause for disapproval of the Application or <br /> sanctions including revocation of any license for which this Application is submitted. <br /> (10) 1 confirm that the applicant corporation and each individual listed in the ownership section of the application is in <br /> good standing with the Massachusetts Department of Revenue and has complied with all laws of the Commonwealth <br /> relating to taxes,reporting of employees and contractors, and withholding and remitting of child support, <br /> Date: <br /> Signature-.( <br /> Title: President <br />