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APPLICATI ICENSE <br /> 8. FINANCIAL DISCLOSURE <br /> A.Purchase Price for Real Estate 0.00 <br /> B.Purchase Price for Business Assets 251000,.00 <br /> A <br /> C.Other*(Please specify below) !0 *Oth�er Cost(s):(i.e. Costs associated with License Transaction <br /> including,but not limited to: Property price, Business Assets, <br /> D.Total Cost 25,0100.00 Renovations costs,Construction costs, Initial Start-up costs, <br /> 11 Inventory costs, or specify other costs):" <br /> SOURCE OF CASH CONTRIBUTION <br /> Please provide documentation of available funds.(E.g.Bank or other Financial institution Statements, and Letter,etc.) <br /> Name of Contributor Amount of Contribution <br /> Pam and Jan Aggerbeck 1$25,000.oO <br /> Total 25,000-00 <br /> SOURCE OF FINANCING <br /> Please provide signed financing documentation. <br /> Is the lender a licensee pursuant <br /> Name of Lender Amount Type of Financing to M.G.L.Ch.138. <br /> NA ( Yes No <br /> Yes No <br /> ( Yes No <br /> ( Yes No <br /> FINANCIAL INFORMATION <br /> Provide a detailed explanation of the form(s)and source(s)of funding for the cost identified above. <br /> Pam and Jan Aggerbeck is personally founding this <br /> 9, PLEDGE INFORMATION <br /> Please provide signed pledge documentation. <br /> Are you seeking approval for a pledge?r Yes No <br /> Please indicate what you are seeking to pledge(check all that apply) License Stock Inventory <br /> To whom is the pledge being made? <br /> 4 <br />