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9. FINANCIAL DISCLOSURE <br /> Re aired for the follow*in ransactions: <br /> I.................... <br /> • Change of Officers, Stock or Ownership Interest(E.g. New Stockholder/Transfer or Issuance of Stock) <br /> • Change of Premises Information <br /> • Pledge of License, Inventory or Stock <br /> Purchase Price(s), N/A-NOT AN ACQUISITION <br /> ................ <br /> SOURCE OF CASH CONTRIBUTION <br /> ..................... <br /> Please provide documentation of available funds.(E.g.Bank or other Financial institution Statements,Bank Letter,etc.) <br /> Name of Contributor Amount of Contribution <br /> N/A-NOT AN ACQUISITION <br /> 7, <br /> ......... <br /> Tota[I <br /> --—------- .... ............................................ <br /> ............. ......................---1 <br /> SOURCE OF FINANCING <br /> Please provide signed financing documentation. <br /> Name of Lender Amount Type of Financing Is the lender a licensee pursuant <br /> to M.G.L.Ch.138. <br /> N/A C Yes No <br /> ---------- ... <br /> Yes No <br /> o. <br /> Yes • No <br /> C Yes C No <br /> FINANCIAL INFORMATION' <br /> Provide a detailed explanation of the form(s)and source(s)of funding for the cost'Identified above. <br /> N/A-SEE ABOVE <br /> ..................................... .....—------—-——---------- .......... <br /> 13 <br />