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8. AMENDMENT-Man,aggment A E�enjgp <br /> .................. ............. ,gL__ _t, <br /> Ma ngment A reement:(must fill out all pages in section 8) <br /> Are you requesting approval to utilize a management company through a management agreement? I....... .....-------. ................................................................ <br /> If yes,please fill out section 8. Yes C No <br /> Please provide a narrative overview of the Management Agreement.Attach'additional pages,if necessary. <br /> .........................___---- ------ .......... ...............I.. .................. <br /> IMPORTANT NOTE:A management agreement is where a licensee authorizes a third party to Control the daily operations of the <br /> license premises, While retaining ultimate control over the license,through a written contract. This does not pertain to a liquor <br /> license manager that is employed directly by the entity. <br /> A. MANAGEMENT ENTITY <br /> List all proposed individuals or entities that will have a direct or indirect,beneficial or financial interest in the management Entity(E.g. <br /> Stockholders,Officers,Directors,LLC Managers,LLP Partners,Trustees etc.). <br /> Entity Name .......`,�............ Address Phone <br /> ........... <br /> ...................... .......................................................................................................................................... ........................... <br /> Name of Principal Residential Address SSN <br /> ........ DOB <br /> ........... <br /> .......................... <br /> ............................................................................ .. ....................................­j <br /> ..... . <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> ( (.......... .............................................-.. -- <br /> ... —­­-­--- . C Yes C,No Yes No Yes No............. <br /> .......... .. <br /> .. <br /> Name of,P ............................................... .... ........... <br /> ,rin,c1p0 Residential Address SSN <br /> ................... DOB <br /> .........._­__,­­­........ ..........--- -——------- <br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident <br /> 31-11,................................ <br /> C Yes C No7 C Yes C No <br /> ................-—-­­- <br /> Name of Principal Residential Address SSN <br /> DOB <br /> ......................................... <br /> ................................................. ............................. .......................... ..... <br /> ....................... ........................... .......... L...........................................:_.........:__ <br /> Title and or Position ........................... Percentage of Ownership Director US Citizen MA Resident <br /> ......................................... <br /> .............. ......... <br /> r Yes C No C Yes No C Yes C No <br /> .................. ............... I <br /> 1:E_,, ......................__j ............... <br /> Name of Principal Residential Address SSN DOB- <br /> 7-' <br /> .......................... ............................'I....................... ................... <br /> T,!,t,11,1e and or Position Percentage of Ownership Director US Citizen MA Resident <br /> C <br /> ( Yes Yes C.No No7 <br /> .................. ....... ........ ....................... <br /> CRIMINAL HISTORY <br /> Has any individual identified above ever been convicted of a State,Federal or Military Crime? ( Yes ( No <br /> If yes,attach an affidavit providing the details of any and all convictions.' <br /> 8B, EXISTING MANAGEMENT AGREEMENTS AND INTEREST IN AN ALCOHOLIC BEVERAGES LICENSE <br /> Does any individual or entity identified in question 8A,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 D No � If yes,list in table below.Attach additional pages,if necessary,utilizing the table format below. <br /> .................... ....................................... <br /> e License Name Municipality <br /> Name License Typ <br /> ----------- ..............._......... .... ........... ...................... ........................ <br /> .......... ................. ............ ....................................................... ........ -—---.... ............................. <br /> .............................. ..........____.................. ..................................... .......................__.................. ............................................ -—--... ........ .......... ................ <br /> 11 <br />