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t <br /> APPLICATION FOR A NEW LICENSE <br /> 8. FINANCIAL DISCLOSURE <br /> A.Purchase Price for Real Estate 0,00 <br /> B,Purchase Price for Business Assets 0,00 <br /> C.Other*(Please specify below) 0.00 *Other Cost(s):(i.e.Costs associated with License Transaction <br /> including but not limited to: Property price, Business Assets, <br /> D.Total Cost 0.00 Renovations costs,Construction costs, initial Start-up costs, <br /> 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,Bank Letter,etc.) <br /> Name of Contributor Amount of Contribution <br /> - _ <br /> s+ <br /> _ oB <br /> ;= <br /> _ •T to I - _. -•-- - <br /> o, <br /> I ' <br /> SOURCE OF FINANCING <br /> Please provide signed financing documentation. <br /> Is the fender a licensee pursuant <br /> Name of Lender Amount Type of Financing <br /> to,M.G.L.Ch,13 8. <br /> _.. - s No <br /> - -e <br /> `y 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 /> 9. PLEDGE INFORMATION <br /> Please provide signed pledge documentation. <br /> Are you seeking approval fora pledge?(D Yes Co No <br /> Please indicate what you are seeking to pledge(check all that apply) License © Stock Ej Inventory <br /> To whom is the pledge being made? <br /> 4 <br />