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8. AMEN DMENT-Mammmmuum,nggemenmvrnt A, r g eemannent
<br /> ——---------.......... ........ ........-
<br /> f7man �qerr t,Awree fill otjtal p ' * t! n,a
<br /> -A — nrvrvn -m—mgm;(mi,ist 1, ages in sec,o
<br /> Are you requesting approval'to utilize a management company through a management agreement? . .....If yes, please fill out section 8. ( Yes NP
<br /> Please provide a narrative overview of the Management Agreement.Attach additional pages,if necessary. ................. .....................................
<br /> . ...........................1-1-1.................................. ......................
<br /> n����������������� ... �� n,,,,,,,,,,,,,,,, ,� .. ��.�����.��
<br /> IMPORTANT NOTE:A management agreement is where a licensee authorizes a third party to control the daily operation's 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 ENT11111TY
<br /> List all proposed individuals or entities that will have a direct or indirect,beneficial or financial interest in the rn a nagement Entity(E.g.
<br /> Stockholders,Officers,Directors,LLC Managers,LLP Partners,Trustees etc.).
<br /> Entity Name ........... Address Phone
<br /> ..........
<br /> ............ ................._................
<br /> Name of Principal . mrn grnrnnnnn rResidential Address SSN DOB
<br /> .............................
<br /> ............................................
<br /> Title and or Position Percentage of Ownership irect D or US Citizen
<br /> MA Resident
<br /> ( Yes ( No ( Yes r No
<br /> ............... ...................
<br /> Name of Principal Residential Address SSN
<br /> ........I...... ............... DOB
<br /> IF
<br /> .............................................
<br /> Title and or Position Percentage of Ownership Director US Citizen MA Resident
<br /> .............................................................................................................----— .........................................——" 7
<br /> I�C'Yes C No , FI—/-
<br /> L ............. ( Yes ( No
<br /> N al"T" e of P ri n c i pa I Residential Address SSN DOB
<br /> ............................. .......
<br /> Title and or Position Percentage of Ownership Director US Citizen................. MA Resident
<br /> .1 ............. ...................................................................................
<br /> I Yes C No C Yes C No ( Yes ( No
<br /> ....................
<br /> Name of Principal Residential Address SSN DOB
<br /> ......................................................................
<br /> 1.,. ....__.....................................................I -_oi L................. .............
<br /> Title and or Position
<br /> Percentage of Ownership Director US Citizen MA Resident
<br /> .......................—-——------ .........._ -------- .............. ......................I................
<br /> C Yes ( ,No Yes No Yes C No
<br /> E.............. �.I-ir........... ....... ...........
<br /> CRIMINAL HISTORY
<br /> ........... .......................
<br /> ................................................................
<br /> Has any individual identified above ever been convicted of a State,Federal or Military Crime? C Yes No
<br /> If yes,attach an affidavit providing the details of any and all convictions. 1�
<br /> 813, 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 No If yes,list in table below..Attach additional pages,if necessary,utilizing the table format below,
<br /> ................................... _ rnnnnn ........................
<br /> License Name Municipality
<br /> ........................................................
<br /> Name License Type
<br /> .................................................................................. ............ rnrn ..........................
<br /> ............... ..................... ............ ........................
<br /> .......................
<br /> ............... .......... ........ ............ .......... ...... ............................ .. ........ ...............
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