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The Commonwealth of Massachuset <br /> Alcoholic beverages Control Commis-Tian <br /> �. 95 Fourth Street "cite 3, Chelsea,MA 010-25 <br /> www.mass.,gavr'ahee <br /> RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION <br /> N <br /> MONETARY TRANSMITTAL FORM <br /> APPLICATION FOR.AME I I/IEI IT-C�la�r� �� of Lic s Classification <br /> APPU A1TION SHOULD BE COMPLETED ON-U E, P" I TEQ,SIGNEQ,AND SUBMITTED E TO THE LOCAL <br /> LICENSING AUTHORITY. <br /> EC T CODE: RETA <br /> Please make$200,00 payment ent lane-AE CC 01 YN ir"-` 1 'f , .T <br /> PAYMENT MUST DENOTE THE NAME E OF THE LICENSEE CORPORATION,.LLC,. PARTNERSHIP,DB INDIVIDUAL AND INCLUDE THE <br /> PAYMENT RECEIPT <br /> ABCC LICENSE NUMBER(IF AN EXISTING LICENSEE,CAN BE OBTAINED FROM THE CITY) 06?� <br /> 11 00003 <br /> mmmmmmmmm <br /> ENTITY/LICENSEE NAME ................................................N E "►1 � I�U I E C�J I E I" AI�JA E II E NT, I P . <br /> ADDRESS j22. EA►NE, T DRIVE <br /> CITY/TOWN A► H F'� ,� mmmmmmm <br /> ' TOWN E STATE MA ZIP CODE 2 49 <br /> For the following transactions (Check all that apply): <br /> New License 0 Change of Location ®®. � � Change Corporate 5tru ure(i.e.MCorp/1_1_�C) <br /> �I"1df1 ea►f Class ti,�e.Annuafl5�ascrr�a�f� <br /> Transfer of License El Alteration of Licensed'Premises Change of License Type(i.e.club t restaurant) El Pledge of Collateral(i.e.License/Stock) <br /> Change of Manager Change corporate Name Change of Category(i.e.All Alcohol/Wine,Malt) � manage ment/+ perating Agreement <br /> _ Change of Officers/ Change of Ownership Interest issuance/Transfer of Stock/New Stockholder Change of Hours <br /> Directors/LLC tanager (LLC Members/LLP Partners, <br /> Trustees) Other L] Change of DBA <br /> ......... <br /> THE LOCAL LICENSING AUTHORITY MUST MAIL THIS <br /> TRANSMITTAL FORM ALONG WITH <br /> COMPLETED APPLICATION, ANC SUPPORTING DOCUMENTS TO: <br /> lcohofic Beverages Control Commission <br /> 95Fourth Street,Suite <br />