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S. AMENDMENT-Change of Manager <br /> Change of License Manager <br /> A. MANAGER INFORMATION <br /> The individual that has been appointed to manage and control the licensed business and premises. <br /> Proposed Manager Name Zohaib Shahid Date of Birth RiH] SSN <br /> Residential Address <br /> Email Phone <br /> Please indicate how many hours per week <br /> you intend to be on the licensed premises 50 Last-Approved License Manager Mohammad Abbas Sattar <br /> B.CITIZENSHIP/BACKGROUND INFORMATION <br /> Are you a U.S.Citizen?* QYes ()No *Manager must be a U.S.Citizen <br /> If yes,attach one of the following as proof of citizenship US Passport,Voter's Certificate,Birth Certificate or Naturalization Papers. <br /> Have you ever been convicted of a state,federal,or military crime? ()Yes QNo <br /> If yes,fill out the table below and attach an affidavit providing the details of any and all convictions.Attach additional pages,if necessary, <br /> utilizing the format below. <br /> Date Municipality Charge Disposition <br /> C. EMPLOYMENT INFORMATION <br /> Please provide your employment history.Attach additional pages, if necessary, utilizing the format below. <br /> Start Date End Date Position Employer Supervisor Name <br /> 2010 2016 Cashier Ye Olde Splr�t Shoppe,5agamareBeadi <br /> 2010 2016 Cashier 7-Eleven,W.Yarmouth,MA <br /> 20.16 2018 Cashier ; <br /> mash pee Mart,Mashpee,MA <br /> D.PRIOR DISCIPLINARY ACTION <br /> Have you held a beneficial or financial interest in,or been the manager of,a license to sell alcoholic beverages that was subject to <br /> disciplinary action? C)Yes QNo If yes,please fill out the table.Attach additional pages,if necessary,utilizing the format below. <br /> Date of Action Name of License State City Reason for suspension,revocation or cancellation <br /> !hereby swear under the pains and peva!les o erjury that the information I have provided in this application is true and accurate: <br /> Date <br /> Manager's Signature },- t < , .� - JI <br />