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Home My WebLink About07 Gannons Chg MgrThe Commonwealth of Massachusetts Alcoholic Beverages Control Commission 95 Fourth Street, Suite 3, Chelsea, MA 02150-2358 www.mass.gov/abcc RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION MONETARY TRANSMITTAL FORM AMENDMENT-Change of Manager APPLICATION SHOULD BE COMPLETED ON-LINE, PRINTED, SIGNED, AND SUBMITTED TO THE LOCAL LICENSING AUTHORITY. ECRT CODE: RETА Please make $200.00 payment here: ABCC PAYMENT WEBSITE PAYMENT MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL AND INCLUDE THE PAYMENT RECEIPT ABCC LICENSE NUMBER (IF AN EXISTING LICENSEE, CAN BE OBTAINED FROM THE CITY) ENTITY/LICENSEE NAME 959 Bearses, In ADDRESS 059 Bearses way CTY/TOWN Hannis For the following transactions (Check all that apply): ☐ New License Trapsfer of License ☑Change of Manager Change of Officers/Directors/LLC Managers ☐Change of Location ☐ Alteration of Licensed Premises Change Corporate Name Change of Ownership Interest (LLC Members/LLP Partners,Trustees) ALC-43 STATE MA ZIP CODE D2) ☐Change of Class (i.e. Annual / Sesonal) Change of License Type (i.e, club /restawrant) Change of Category (i.e. All Alcohol/Wine, Mat) Issuance/Transfer of Stock/New Stockholder Other ☐Change Corporate Structure (.e. Corp/ LLC) Pledge of Collateral i.e. Likcense/Stock) Management/Operating Agreement ☐ Change of Hours ☐ ☐ Change of DBA THE LOCAL LICENSING AUTHORITY MUST SUBMIT THIS APPLICATION ONCE APPROVED VIA THE ePLACE PORTAL Alcoholic Beverages Control Commission 95 Fourth Street, Suite 3 Chelsea, MA 02150-2358 The Commonwealth of Massachusetts Alcoholic Beverages Control Commission 95 Fourth Street, Suite 3, Chelsea, MA 02150-2358 www.mass.gov/abcc 1. BUSINESS ENTITY INFORMATION Entity Name 959 Bearses Inc 2. APPLICATION CONTACT AMENDMENT-Change of Manager Municipality Barnstaable Change of License Manager ABCC License Number ALC-43 The application contact is the person who should be contacted with any questions regarding this application.Name Title Email Dennis Aceto 3A. MANAGER INFORMATION cwner Phone Idacetos4ecomcost net The individual that has been appointed to manage and control of the licensed business and premises. Proposed Manager Name Laura Guindon Date of Birth 518-344-8416 Residential Address Email Please indicate how many hours per week you intend to be on the licensed premises 40 Last-Approved License Manager michael Ganncn 3B. CITIZENSHIP/BACKGROUND INFORMATION Are you a U.S. Citizen/Qualified Alien under the Immigration and Nationality Act?Yes ONo If yes, attach one of the following documents: US Passport, Voter's Certificate, Birth Certificate, Naturalization Papers, Green Card or EmploymentAuthorization Document.YesNO Have you ever been convicted of a state, federal, or military crime? If yes, fill out the table below and attach an affidavit providing the details of any and all convictions. Attach additional pages, if necessary,utilizing the format below. Date Municipality Charge Disposition 3C. EMPLOYMENT INFORMATION Please provide your employment history. Attach additional pages, if necessary, utilizing the format below. Start Date End Date Position Employer Supervisor Name 8/3023 Presont marager Gannors Tavern Dennis Acetes 6/2012 7/2023 Paralegal CopelodTAled Escraw Angelaphilbrook 3D. PRIOR DISCIPLINARY ACTION Have you held a beneficial or financial interest in, or been the manager of, a license to sell alcoholic beverages that was subject to disciplinary action? OYes ONO If yes, please fill out the table. Attach additional pages, if necessary, utilizing the format below. Date of Action Name of License State City Reason for suspension, revocation or cancellation I hereby swear under the pains and penalties of perjury that the information I have provided in this application is true and accurate: Manae's Stnatye ui Date 17lac/25 APPLICANT'S STATEMENT Lacva Guindon Authorized Signatory the:sole proprietor;partner;corporate principal; ☐ LLC/LLP manager of 959 Bearses, Inc. Name of the Entity/Corporation hereby submit this application (hereinafter the "Application"), to the local licensing authority (the "LLA") and the Alcoholic Beverages Control Commission (the "ABCC" and together with the LLA collectively the "Licensing Authorities") for approval. I do hereby declare under the pains and penalties of perjury that I have personal knowledge of the information submitted in the Application, and as such affirm that all statements and representations therein are true to the best of my knowledge and belief. I further submit the following to be true and accurate: (1) (2) I understand that each representation in this Application is material to the Licensing Authorities' decision on the Application and that the Licensing Authorities will rely on each and every answer in the Application and accompanying documents in reaching its decision; I state that the location and description of the proposed licensed premises are in compliance with state and local laws and regulations; (3) I understand that while the Application is pending, I must notify the Licensing Authorities of any change in the information submitted therein. I understand that failure to give such notice to the Licensing Authorities may result in disapproval of the Application; (4)I understand that upon approval of the Application, I must notify the Licensing Authorities of any change in the ownership as approved by the Licensing Authorities. I understand that failure to give such notice to the Licensing Authorities may result in sanctions including revocation of any license for which this Application is submitted; (5)I understand that the licensee will be bound by the statements and representations made in the Application, including, but not limited to the identity of persons with an ownership or financial interest in the license; (6)I understand that all statements and representations made become conditions of the license; (7)I understand that any physical alterations to or changes to the size of the area used for the sale, delivery, storage, or consumption of alcoholic beverages, must be reported to the Licensing Authorities and may require the prior approval of the Licensing Authorities; (8)I understand that the licensee's failure to operate the licensed premises in accordance with the statements and representations made in the Application may result in sanctions, including the revocation of any license for which the Application was submitted; and (9) (10) I confirm that the applicant corporation and each individual listed in the ownership section of the application is in good standing with the Massachusetts Department of Revenue and has complied with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting of child support. I understand that any false statement or misrepresentation will constitute cause for disapproval of the Application or sanctions including revocation of any license for which this Application is submitted. Daer C Title:anager Date: 1:2/29/35 The Board of Directors or LLC Managers of ENTITY VOTE 959 Bearses Ine.Entity Name duly voted to apply to the Licensing Authority of HjannisCity/Town Commonwealth of Massachusetts Alcoholic Beverages Control Commission on and the 12/29/55 Date of Meeting For the following transactions (Check all that apply): Change of Manager Other "VOTED: To authorize laura Guinden Name of Person to sign the application submitted and to execute on the Entity's behalf, any necessary papers and do all things required to have the application granted." "VOTED: To appoint Laura Guindon Name of Liquor License Manager as its manager of record, and hereby grant him or her with full authority and control of the premises described in the license and authority and control of the conduct of all business therein as the licensee itself could in any way have and exercise if it were a natural person residing in the Commonwealth of Massachusetts." A true copy attest, Corporate Officer /LLC Manager Signature (Print Name) For Corporations ONLY A true copy attest, CemCorporation Clerk's Signature Pannis5 Aceto (Print Name)