03/02/2020 BOARD OF SELECTMEN Agenda Packet

Home Browse Search

11C, PREVIOUSLY HELD INTEREST IN AN ALCOHOLIC BEVERAGES LICENSE Has any individual or entity identified in question 11 A,and applicable attachments,ever held a direct or indirect,beneficial or financial interest in a license to sell alcoholic beverages,which is not presently held.? Y'e s No if yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. Name License Type License Name Municipality 11D, PREVIOUSLY HELD MANAGEMENT AGREEMENT Has any individual or entity identified in question 11 A,and applicable attachments,ever held a management agreement with any other Massachusetts licensee.? Yes E] No If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. Licensee Name License Type- Municipality Date(s)of Agreement 11E, DISCLOSURE OF L110ENSE DISCIPLINARY ACTION' Has any of the disclosed licenses listed in questions in section 11 B,11 C,11 D ever.been suspended,revoked or cancelled? Yes [] No [] If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. Date of Action Name of License City Reason for suspension,revocation or cancellation .. . ........... 11F, TERMS OF AGREEMENT a.Does the agreement provide for termination by the licensee.? Yes No b.Will the licensee retain control of the business finances? Yes No c.Does the management entity handle the payroll for the business? Yes No d.Management Term Begin Date j e.management Term End Date f.How will the management company be compensated by the licensee?(check all that apply) $per month/year(indicate amount) %of alcohol sales(indicate percentage) El %of overall sales(indicate percentage) E other(please explain) ABCC Licensee Officer/LLC Manager Management Agreement Entity Officer/LLC Manager Signature: Signature: Title Title: -. Date: Date: 7