Laserfiche WebLink
APPLICATION FOR AMENDMENT-Change of Officers, Stock or Ownership Interest <br /> 3. CURRENT OFFICERS, STOCK OR OWNERSHIP INTEREST <br /> List the individuals and entities of the current ownership. Attach additional pages if necessary utilizing the format below. <br /> Name of Principal Title/Position Percentage of Ownership <br /> F—MothyT.Janszen FLLC Manager 0% <br /> Name of Principal Title/Position Percentage of Ownership <br /> Charles O.Noyes LLC Manager,President 10% <br /> Name of Principal Title/Position Percentage of Ownership <br /> [Goodloe M.Partee General Counsel,Secretary 0% <br /> Name of Principal Title/Position Percentage of Ownership <br /> [Brent B.Bickett ILLC Manager 7 FO./. <br /> Name of Principal Title/Position Percentage of Ownership <br /> Gregory Hayes [Treasurer 10% <br /> Name of Principal Title/Position Percentage of Ownership <br /> [99 Restaurants,LLC FLL Member 7 F100% <br /> 4. INTEREST IN AN ALCOHOLIC BEVERAGES LICENSE <br /> Does any individual or entity identified in question 6,and applicable attachments, have any direct or indirect,beneficial or financial <br /> interest in any other license to sell alcoholic beverages? Yes ® No © If yes,list in table below.Attach additional pages,if <br /> necessary,utilizing the table format below. <br /> Name License Type License Name Municipality <br /> See Exhibit B <br /> 5. PREVIOUSLY HELD INTEREST IN AN ALCOHOLIC BEVERAGES LICENSE <br /> Has any individual or entity identified identified in question 6,and applicable attachments,ever held a direct or indirect,beneficial or <br /> financial interest in a license to sell alcoholic beverages,which is not presently held? Yes ® No [- <br /> If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. <br /> Name License Type License Name Municipality <br /> See Exhibit C <br /> 6 DISCLOSURE OF LICENSE DISCIPLINARY ACTION <br /> Have any of the disclosed licenses listed in question 6Aor 6B ever been suspended,revoked or cancelled? <br /> Yes ® No F If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. <br /> Date of Action Name of License City Reason for suspension,revocation or cancellation <br /> See Exhibit D <br /> 3 <br />