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1 MANAGEMENT AGREEMENT <br /> Are you requesting approval to utilize a management company through a management agreement? <br /> if yes,please fill out section 11. I�.' Yes Ic <br /> Please provide a narrative overview Of the Management Agreement.Attach additional pages,,if necessary. <br /> IMPORTANT NOTE:A management agreement is where a licensee authorizes a third party to control the daily operations of <br /> the license-premises, while retaining ultimate control over the license,through a written contract. This does notpertain to a <br /> liquor license manager that is employed directly by the entity. <br /> 11A. MANAGEMENT ENTITY <br /> _�.. � <br /> individuals or entities that <br /> List all <br /> proposed ` ` ������s that will have a director indirect,beneficial or financial interest in the management Entity <br /> (E.g. <br /> Stockholders,officers,Directors,LL+C Managers,LLP Partners,Trustees etc.). <br /> Entity Name Address Phone <br /> ��mmmm� .�� r� �anmmmmm <br /> Name of Principal s SSN <br /> R <br /> �es�»»»»>�± r�tial AddressDOB <br /> ....................................................­­........._' <br /> Title and or Position,_.,,.,,. ........................... Percentage of Ownership Director US Citizen MA Resident <br /> Yes No Yes ' No Yes r No <br /> Name of Principal Residential Address SSN DOB <br /> ............... <br /> ww WWWWWW � <br /> Title and or Position Percentage of Ownership Director US Citizen u« nn non a. MA Resident <br /> mmmm W <br /> : .... <br /> "`Yes C No "`Yes No <br /> blame of Princip <br /> al Residential Address SSN DOB <br /> .......................... <br /> ........... <br /> Title t I a rnnnn�.--� _-�rrrrr����������,���,µ��n��,� ��RRR� <br /> or Position <br /> Percentage of Ownership Director US Citizen MA Resident <br /> Yes No nR n <br /> "` "`Yes " No """Yes No <br /> . ..... <br /> Name of Principal .. r� Residential Address SSN DOB <br /> f <br /> Title a n d or P mmmmmmm n <br /> osition m <br /> mmmmm <br /> Percentage of ownership Director US Citizen M F�esid nt <br /> Percen . <br /> Yes No Yes r No <br /> CRIMINAL HISTORY <br /> Has any individual identified above ever been convicted of a State,federal or Military Crime, Y <br /> es ( No <br /> If yes,attach an affidavit providing the details of any and all convictions. <br /> 11B. EXISTING MA IAGE1M, ENT AGREEMENTS AND INTEREST IN AN ALCOHOLIC � EVE A► <br /> m GES <br /> LICENSE <br /> Does any individual or entity identified in question 11A,and applicable attachments, have any direct or indirect,beneficial or financial <br /> interest in any other license to sell,alcoholic beverages,and or have an active management agreement with any other licensees? <br /> Yes [] No lvr If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. <br /> W <br /> Name License Type License Name Municipality <br /> mmmmw <br />