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mm,mm, <br /> APPLICANT'S TATE'VIEIT <br /> ........................... w �w the. sale proprietor, � partner, Corporate principal; El �.L /LLI manager <br /> Signatory <br /> of Ate- <br /> Name of the.Entity corporation <br /> hereby submit this application (hereinafter the "Application"),to the local licensing authority(the"LLA"}and the'Alcoholic <br /> Beverages Control Commission (the "AB CC" and together with the LLA collectively the `'Licensing Authorities")for approval. <br /> I do hereby declare under the pains and penalties of perjury that I have personal knowledge of the information submitted in the <br /> Application, ,and as such affirm that all statements and representations therein are true to the best of my knowledge and belief. <br /> I further submit the following to be true and accurate: <br /> (1) 1 understand that each representation in this Application is material to the Licensing Authorities'decision on the <br /> Application and that the Licensing Authorities will rely on each and every answer in the Application and accompanying <br /> pp <br /> documents in reaching its decision; <br /> c2 1 state that the location and description of the proposed licensed premises are in compliance with state <br /> and local laws and regulations; <br /> (3) 1 understand that while the Application is pending, I must notify the Licensing Authorities of any change in the <br /> information submitted therein. I understand that failure to give such notice to the Licensing Authorities may result in <br /> disapproval of the Application; <br /> (4) 1 understand that upon approval of the Application, I must notify the Licensing Authorities of any change in the <br /> ownership as approved by the Licensing,Authorities. I understand that failure to give such notice to the <br /> Licensing Authorities may result in sanctions including revocation of any license for which this Application is submitted; <br /> (5) 1 understand that the licensee will be bound by the statements and representations made in the Application, including, <br /> g <br /> but not limited to the identity of persons with an ownership or financial interest in the license; <br /> (6) 1.und+ rstand that all statements and representations made become conditions of the license; <br /> (7) 1 understand that any physical alterations to or changes to the size of the area used for the sale,delivery, storage, or <br /> consumption of alcoholic beverages, must be reported to the Licensing Authorities and may require the prior approval <br /> of the Licensing Authorities; <br /> (g) 1 understand that the licensee's failure to operate the licensed premises in accordance with the statements and <br /> representations rude in the Application may result in sanctions, including the revocation of any license for which the <br /> Application was submitted; and <br /> (9) 1 understand that any false statement or misrepresentation will constitute cause for disapproval of the Application or <br /> sanctions including revocation of any license for which this Application is submitted. <br /> (10) 1 confirm that the applicant corporation and each individual listed in the ownership section of the application is in <br /> good standing with the Massachusetts ['Department of Revenue and has complied with all laws of the Commonwealth <br /> relating to takes, reporting of employees and contractors,and withholding and remitting of child support. <br /> Signature: <br /> i - Gate. <br /> .................................. <br /> kal <br /> t <br /> ..�mi. m�wrnw:mmi..urowwimmPi" imir� � www, <br /> ----- <br /> Title: , <br />