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The Commonwealth of Massachusetts <br /> Alcoholic Beverages Control Commission <br /> 239 Causeway Street,Boston,MA 02114 <br /> a - -- wo,minass.gov/abcc <br /> ac <br /> APPLICATION FOR AMENDMENT-Change of Officers. Stock or Ownership Interest <br /> xi Change of Officers/ Directors/LLC Managers 0 Change of Stock Interest <br /> • DOR Certificate of Good Standing (e.g.New Stockholders or Transfer or Issuance of Stock) <br /> • DUA Certificate of Compliance . DOR Certificate of Good Standing <br /> • Change of Officer/Directors Application <br /> • DUA Certificate of Compliance <br /> • CORI Authorization • Change of Stock Application <br /> • Vote of the Entity . CORI Authorization <br /> • Business Structure Documents • Financial Statement <br /> • If Sole Proprietor, Business Certificate <br /> • If partnership, Partnership Agreement • Vote a the Entity <br /> • Purchase&Sale Agreement <br /> • If corporation or LLC,Articles of Organization . Supporting Financial Records <br /> from the Secretary of the Commonwealth <br /> • Advertisement(New Stockholdi-. Only) <br /> • Business Structure Documents <br /> • If Sole Proprietor,Business Certificate <br /> pChange of Ownership Interest If partnership,Partnership Agreement <br /> (e.g. LLC Members,LLP Partners,Trustees etc.) • If corporation or LLC,Articles of Organization <br /> from the Secretary of the Commonwealth <br /> • DOR Certificate of Good Standing <br /> • DUA Certificate of Compliance 0 Non-Profit Club Change of Officers/ Directors <br /> • Change of Stock Application • DOR Certificate of Good Standing <br /> • CORI Authorization • DUA Certificate of Compliance <br /> • Financial Statement • Change of Officer/Directors Application <br /> • Vote of the Entity • Vote of the club signed by an approved officer <br /> • Purchase&Sale Agreement • Business Structure Documents-Articles of <br /> • Supporting Financial Records Organization from the Secretary of the Commonwealth <br /> • Advertisement(New Stockholder Only)* <br /> • Business Structure Documents p Management Agreement <br /> • If Sole Proprietor,Business Certificate . DOR Certificate of Good Standing <br /> • If partnership, Partnership Agreement . DUA Certificate of Compliance <br /> • If corporation or LLC,Articles of Organization . Management Agreement <br /> from the Secretary of the Commonwealth • Vote of Entity <br /> *If abutter notification and advertisement is required for transaction,please see the local licensing authority. <br /> 1. BUSINESS ENTITY INFORMATION <br /> Entity Name Municipality ABCC License Number <br /> F199 West,LLC F��ee 00046-RS-0670 <br /> Please provide a narrative overview of the transaction(s)being applied for.Attach additional pages,if necessary. <br /> Kurt Schnaubelt is now the CFO and an LLC manager of the licensed entity,and W,Craig Barber is the CEO and an LLC manager,of the licensed entity. <br /> Brent Bickett,Timothy Janszen and Greg Hayes have been removed as LLC Managers. There are also changes to the upper-tier ownership structure. <br /> See additional page and Exhibit A for further information on the changes. <br /> APPLICATION CONTACT <br /> The application contact is the person who should be contacted with any questions regarding this application. <br /> Name Title Email Phone <br /> [Joseph H.Devlin Attorney jdevlin@devlinlawoffices.com � � <br /> 1 <br />