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APPLICATION FOR A NEW LICENSE <br /> 8. FINANCIAL DISCLOSURE <br /> ............... ......--—-... .......... ............ <br /> A.Purchase Price for Real Estate <br /> ........... ....... <br /> B.Purchase Price for Business Assets <br /> C.Other (Please specify below) *Other Costs}: (i.e. Costs associated with License Transaction <br /> including but not limited to: Property price, Business Assets, <br /> D.Total Cost Renovations costs, Construction costs, Initial Start-up costs,. <br /> Inventory costs, or specify other costs).-" <br /> SOURCE OF CASH CONTRIBUTION <br /> .......... <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 /> Bank of America $1 Ok <br /> ......................... ........... . ............. ........... .................................. <br /> ....................... .................. <br /> li <br /> .......... <br /> ............. <br /> Totalt <br /> ................. ............ ........... ...................... <br /> ............. ...... <br /> SOURCE OF FINANCING <br /> Please provide signed,financing documentation. <br /> ...........­,­,............ <br /> Name of Lender Amount Type of Financing Is the lender a licensee pursuant <br /> to M.G.L.Ch.138. <br /> ...................... ........................ <br /> . ........ ...................................................... ———------ Yes No <br /> ......... Yes No <br /> Yes (7 No <br /> r Yes r No <br /> FINANCIAL INFORMATION <br /> ............ <br /> Provide a detailed explanation of the form(s)and source(s)of funding for the cost identified above. <br /> ............ ................... .................. <br /> 9* PLEDGE INFORMATION .............. <br /> ........................ <br /> Please provide signed pledge documentation. <br /> Are you seeking approval for a pledge?r Yes or N o <br /> Please indicate what you are seeking to pledge(check all that apply <br /> D License Stock Inventory <br /> .............. <br /> To whom is the pledge being made? <br /> ........ ........ .............................__'........ ................ ....... <br /> 4 <br />