Laserfiche WebLink
APPLICATION FOR A NEW LICENSE <br /> 8.. FINANCIAL DISCLOSURE <br /> ................................................. <br /> A,.Purchase Price for Real Estate 21500 <br /> ............................................... <br /> B.Purchase Price for Business Assets <br /> C.Other*(Please specify below) *Other Cost(s): (i.e. Costs associated with License Transaction <br /> .............. <br /> mmm............... including but not limited to; Property price, Business Assets., <br /> D.Total Cost 2,500 Renovations costs, Construction costs., Initial Start-up costs, <br /> ............. ............-.......... Inventory costs., or specify other costs):" <br /> SOURCE OF CASH CONTRIBUTION <br /> Please provide documentation of available funds.(E.g.Bank or other Financial institution Statements,Bank Letter,etc.) <br /> ..... .......I <br /> Name of Contributor Amount of Contribution <br /> �Michael Morrison and Stephanie Raine $2,500.00 <br /> ............. ........ <br /> Total $2f5OO.O , <br /> ............... ..... s7 <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 /> Yes C No <br /> C Yes C No <br /> Yes No <br /> Yes No <br /> C Yes No <br /> Yes No <br /> ............ <br /> FINANCIAL INFORMATION <br /> Provide a detailed explanation of the form(s)and source(s)of funding for the cost identified above. <br /> ........................................ <br /> ........... ............ ..... .... .................................... ................. ...... ........... .. ............ -—... - ................................................. ......................... .................._"',.................................................... .......... <br /> 9, PLEDGE INFORMATION <br /> Please provide signed pledge documentation. <br /> Are you seeking approval for a pledge?r Yes No <br /> Please indicate what you are seeking to pledge(check all that apply) License E] Stock E] Inventory <br /> ............ <br /> To whom is the pledge being made? <br /> ..............................................................................­­................................ <br /> 4 <br />