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11. MANAGEMENT AGREEMENT' <br /> Are you requesting approval to utilize a management company through a management agreement.? Yes No <br /> If yes,please fill,out section 11. <br /> Please provide a narrative overview of the Management Agreement.Attach additional pages,if necessary. <br /> IMPORTANTNOTE:A management agreement is where a licensee authorizes a third party to control the daily operations of <br /> the license premises,while retaining ultimate control over the license,through a written contract. This does not pertain to a <br /> liquor license manager that is employed directly by the entity. <br /> 11A, M,ANAGEMENT' EN'TITY <br /> List all proposed individuals or entities that will have a direct or indirect,beneficial or financial'Interest in the management Entity(E.g. <br /> Stockholders,Officers,Directors,LL,C Managers,LLP Partners,Trustees etc.). <br /> Entity Name Address Phone <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> Yes No C Yes C No Yes C No <br /> Name of Principal Residential Address SS N DOB <br /> Title and or Position Percentage of Ownership Director LA'S Citizen MA Resident <br /> ( Yes ( No Yes C No C Yes No <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> ( Yes ( No Yes C No ( Yes ( No <br /> -'- <br /> Name of Principal Residential Address Z>SN DOB <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> I <br /> C Yes C No C Yes C No C Yes C No <br /> CRIMINAL HISTORY <br /> Has any individual identified above ever been convicted of a State,Federal or Military Crime.? Yes No <br /> If yes,attach,an affidavit providing the details of any and all convictions. <br /> 11B, EXISTING MANAGEMENT AGREEMENTS AND INTEREST IN AN ALCOHOLIC BEVERAGES <br /> LICENSE <br /> Does any individual oir entity,identified in question 11 A,and applicable attachments, have any direct or indirect,beneficial or financial <br /> interest in any other license to sell alcoholic beverages;and or have an active management agreement with any other licensees? <br /> Yes No If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. <br /> Name License Type License Name Municipality <br /> 6 <br />