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APPLICATION FOR ANEW LICENSE <br /> P.-CORPORATE STRUCTURE�611 PO I <br /> Entity Legal Structure LLC ........................ ------ Date of Incorporation F,Ma'r 7,2020 <br /> ....... .......... -—------------............... <br /> .............. mRR ...................................... <br /> ........... <br /> State of Incorporation [Massachusetts Is the Corporation publicly traded? C Yes No <br /> ............... ................................. ...................... <br /> 6., PROPOSED OFFICERS OCK 0 OWNERSHIP INTEREST <br /> A T� <br /> List all,individuals or entities that will have a direct or indirect,beneficial or financial interest in this license(E.g.Stockholders,Officers, <br /> Directors,LLC Managers,LLP Partners,Trustees etc.).Attach additional page(s)provided,�if necessary,utilizing Addendum A. <br /> • The individuals and titles listed in this section must be identical to those filed with the Massachusetts Secretary of State. <br /> • The individuals identified in this section,as well as the proposed Manager of Record,must complete a CORI Release Form. <br /> • Please note the following statutory requirements for Directors and LLC Managers: <br /> On Prernlises(E,g.Restau rant/Club/Hotel)Directors or LLC Managers -At least 50%must be US citizens; <br /> Off Premises(Lliquor Store)Directors or LLC Managers -All must be US citizens and a majority must be <br /> Massachusetts residents. <br /> If you area Multi-Tiered Organization,please attach a flowchart identifying each corporate interest and the individual owners of <br /> each entity as well as the Articles Of Organization for each corporate entity. Every individual must be identified in Addendum A. <br /> Name of,"Principal Residential Address SSN <br /> DOB <br /> Mir hael T. Morrison <br /> mmm <br /> .............. <br /> ,Title and or Position --,,,,,,,,-Percenta ge of Ownershi Director/LLC Manager Us Citizen MA Resident <br /> Manager 50% (o Yes No Yes C No (*' Yes No <br /> Name of Principal Residential Address <br /> .............. Racine <br /> SSN DOB <br /> Stephanie M. K. <br /> Tile-` and or Position I.Percentage of Ownershi Director/LLC Manager US Citizen MA'Resident <br /> Manager 50% <br /> ........, ('* Yes No Yes No ro" Yes C No <br /> E, <br /> Name of Princimmmm <br /> pal Residential Address SSN <br /> . ..... DOB <br /> wuw <br /> Title and or Position Percentac e of Ow,nelrsh <br /> j..................... Director/LLC Manager US Citizen MA Resident <br /> mm <br /> FC Yes No C Yes Noo <br /> ( Yes No <br /> Name of Principal Residential Address SSN <br /> DOB <br /> ................ mmmmmmmmmmmmm <br /> =—I F.................�--- <br /> Title and or Position Percenta e of Ownershi Director/LLC Manager 7 1 ip Manag US Citizen MA Resident <br /> E�e s <br /> YesC N Yes No <br /> Name of Principal Residential Address <br /> .............. SS No <br /> mmmm DOB <br /> 'Title and or Position -Perctnj�a °e of 7wnefrs�h Director/LLC Manager Us Citizen MA Resident <br /> mmmm <br /> C Yes C No Yes C No Yes No <br /> Additional pages attached.? C Yes No <br /> CRIMINAL HISTORY <br /> Has any individual listed in question 6,and applicable attachments,ever been convicted of a ( Yes, (*' No <br /> State,Federal or Military Crime?If yes,attach an affidavit providing the details of any and all convictions. <br /> 2 <br />