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The Commonwealth of Massachusetts <br /> Alcoholic Beverages Control Commission <br /> 239 Causeway Street Boston,AM 02114 <br /> www.mass.govlabec <br /> RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION ?919 NOV —4 Aft <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: https://www.paybill.com/mass/abcc/retail/ <br /> PAYMENT MUST DENOTE THE NAME OF THE LICENSEE CORPORATION,LLC,PARTNERSHIP,OR INDIVIDUAL <br /> EPAY CONFIRMATION NUMBER <br /> A.B.C.C. LICENSE NUMBER(IF AN EXISTING LICENSEE,CAN BE OBTAINED FROM THE CITY) 0046-RS-0670 <br /> ENTITY/LICENSEE NAME 199 West, LLC <br /> ADDRESS 18 Ryan's Way <br /> CITY/TOWN iMashpee STATE IMA ZIP CODE 102649 <br /> For the following transactions (Check all that apply): <br /> New License © Change of Location F7 Change of Class(i.e.Annual Seasonal) Change Corporate structure(Le,Corp/LLQ <br /> Transfer of License D Alteration of Licensed Premises Change of License Type(i.e.dub/restaurant) © Pledge of Collateral(i.e.License/Stock) <br /> Change of Manager Change Corporate Name Change of Category(i.e.All Alcohol/Wine,Malt) 0 management/operating Agreement <br /> Change of Officers/ Change of Ownership Interest issuance/Transfer of Stock/New Stockholder [] Change of Hours <br /> rx-1 Directors/LLC Managers (LLC Members/LLP Partners, <br /> Trustees) []Other Change of DBA <br /> THE LOCAL LICENSING AUTHORITY MUST MAIL THIS <br /> TRANSM117AL FORM ALONG WITH <br /> COMPLETED APPLICATION, AND SUPPORTING DOCUMENTS TO: <br /> ALCOHOLIC BEVERAGES CONTROL COMMISSION <br /> 239 CAUSEWAY STREET <br /> BOSTON, MA 02241-3396 <br />