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9. FINANCIAL DISCLOSURE <br /> Rer uired for the following <br /> .......... <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 /> r <br /> SOURCE OF CASH CONTRIBUTION <br /> Please provide documentation of available funds.(E.g.Bank or other Financial institution Statements,Bank Letter,etc.) <br /> ............................................................................... ....... <br /> Name of Contributor Amount of Contribution <br /> ................... <br /> ............................................. <br /> ............................................... <br /> N/A-NOT AN ACQUISITION <br /> -—--------- <br /> .................. .. ........ ... .. ..... <br /> ..... ............ <br /> Tota <br /> .......................... <br /> ........ . ........... <br /> SOURCE OF FINANCING <br /> Please provide signed financing documentation. <br /> Amount Type of Financing Is the lender a licensee pursuant <br /> ............ <br /> Name of Lender <br /> to M.G.L.Ch.138. <br /> N/A i ( Yes ( No <br /> ('Yes No <br /> ............ <br /> Yes "" <br /> No <br /> MW <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 /> N/A-SEE ABOVE <br /> .................... ........... .........................''I'l''''I'll''''I'll'll''''I''�..........——--------------------- ............... <br /> 13 <br />