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6. AMENDMENT-Chan a of Officers Stock or ownership-Interest <br /> Change of Ownership Interest P Change of Stock Mg.New StockholderL <br /> P Change of Officers/Directors ❑ LLC Mana ers/LLP Partners Trustees Transfer or Issuance of Stock <br /> List all individuals or entities that will have a director indirect,beneficial or financial interest in this license(E.g.Stockholders,Officers, <br /> Directors,LLC Managers,LLP Partners,Trustees etc.).Attach additional page(s)provided,if necessary,utilizing Addendum A. <br /> • The individuals and titles listed in this section must be identical to those filed with the Massachusetts Secretary of State. <br /> • The individuals identified in this section,as well as the proposed Manager of Record,must complete a CORI Release Form. <br /> • Please note the following statutory requirements for Directors and LLC Managers: <br /> On Premises(E.g.Restaurant/Club/Hotel)Directors or LLE Managers -At least 50%n must be US citizens; <br /> Off Premises(Liquor Store)Directors or LLC Managers -All must be US citizens and a majority must be <br /> Massachusetts residents. <br /> • if you are a Multi-Tiered Organization,please attach a flow chart identifying each corporate interest and the individual owners of <br /> each entity as well as the Articles of Organization for each corporate entity. Every individual must be identified in Addendum A. <br /> Name of Principal Residential Address SSN _= DOS <br /> Zohaib Shahid t J <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> i 1President,Treasurer,Secretary&Director 100% Q Yes Q Na Q Yes <br /> FQNo Q Yes QNo <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentag e of 0wnershi Director/LLC Manager US Citizen MA Resident <br /> Q Yes QNo Q Yes Q No [EYes QNo <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percents e of Ownershi Director/LLC Manager US Citizen MA Resident <br /> Q Yes QNo ()Yes Q Na Q Yes (j' No <br /> Name of Principal Residential Address SSN DOB <br /> Title and or Position Percentage of Ownershi Director/LLC Manager US Citizen MA Resident <br /> Q Yes Q Na Q Yes Q No Q Yes <br /> )No <br /> Name of Principal Residential Address SSN DOB <br /> F_ L I F <br /> Title and or Position —Percentage of Ownership Director/LLC Manager US Citizen MA Resident <br /> Q Yes Q Na Q Yes Q No Q Yes )No <br /> Name of Principal Residential Address SSN DOB <br /> F_ <br /> Title and or Position Percentage of Ownership Director/LLC Manager US Citizen MA Resident <br /> QYes QNa QYes QNo QYes [1 No <br /> Additional pages attached? Q Yes QNo <br /> CRIMINAL HISTORY <br /> Has any individual listed in question 6,and applicable attachments,ever been convicted of a Q Yes Q No <br /> State,Federal or Military Crime?If yes,attach an affidavit providing the details of any and all convictions. <br /> MANAGEMENT AGREEMENT <br /> Are you requesting approval to utilize a management company through a management agreement? Q Yes Q• No $ <br /> Please provide a copy of the management agreement. <br />