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Home My WebLink AboutTrader Eds Change of Manager Redacted 081623The 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 Manaser APPLICATION SHOULD BE COMPLETED ON-LINE,PRINTED,SIGNED,AND SUBMITTED TO THE LOCAL LICENSING AUTHORITY. ECRT CODE:RETA 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)-vis '00*7^-S \CiCF.ENTITY/LICENSEE NAME 3 I Ac\ADDRESS CITY/TOWN STATE ZIP CODEVlesi-^6.q(oiQ.rAr«0>J For the following transactions (Check all that apply): I I New License I I Transfer of License ^Change of Manager Change of Officers/ Directors/LLC Managers I I Change of Location I I Change Corporate Structure (i.e.Corp/LLC) I I Pledge of Collateral o.e.ucense/stocw □Management/Operating Agreement I I Change of Class (i.e.Annual/Seasonal) □Alteration of Licensed Premises Q Change of License Type I I Change Corporate Name (I.e.club/restaurant) I I Change of Category (i.e.aii AicohoiAvine,Mait) Change of Ownership Interest Issuance/Transfer of Stock/New Stockholder [|[]Change of HoursII(LLC Members/LLP Partners, Trustees) □ I I Other I I 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 JARED PANE 388 Sea Street.Hyannis,MA 02601 ●508-439-9581 Jared.panel@gmail.com MAY 2016 -DECEMBER 2017 GENERAL MANAGER,PILOT HOUSE RESTAURANT ●Managed front of the house staff and schedule ●Placed liquor vendor orders,assisted and contributed to menu ●Managed all functions and events MAY 2018 -MARCH 2020 BARTENDER,TRADER ED'S ●Managed and bartended the outside bar ●Helped manage night life JANUARY 2017 -MARCH 2020 FOH MANAGER,TAP CITY GRILL ●Managed the front of the house ●Closed the restaurant and handled daily cash outs and deposits ●Assisted the General Manager with daily tasks MAY 2020 -SEPTEMBER 2022 GENERAL MANAGER,TUGBOATS RESTAURANT ●Managed front of the house staff and schedule ●Placed liquor vendor orders,assisted and contributed to menu's ●Managed all bars and daily cash outs https://www.ncourt.com/x-press/PrintReceipt.aspxPrintReceipt Payment Confirmation YOUR PAYMENT HAS PROCESSED AND THIS IS YOUR RECEIPT Your account has been billed for the following transaction.You will receive a receipt via email Transaction Processed Successfully. INVOICE #:Cbec8517-9371-44e3-b91a-3e26cf63146e Applicant,License or Registration Number AmountDescription $200.00 $200.00 00138-r-00700sFILINGFEE5-RETAIL Total Convenience Fee:$4.70 Total Amount Paid:$204.70DatePaid:8/7/2023 8:34:06 AM EDT Billing Information First Name: Wayne Payment On Behalf Of License Number or Business Name: 00138-r-00700 s Last Name: KurkerFeeType: FILING FEES-RETAIL Address: 1 Willow Street City: Hyannis State: MA Zip Code: 02601 Email Address: holly@hyannismarina.com 1 of 1 8/7/2023,8:34 AM ENTITY VOTE \The Board of Directors or LLC Managers of 1^Entity Name duly voted to apply to the Licensing Authority of ^\\)V Tsra '3> City/Town Commonwealth of Massachusetts Alcoholic Beverages Control Commission on D^e of Meeting For the following transactions {Check all that apply): pZ^Change of Manager I I Other VOTED:To authorize 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." dcxTe_-(\.VOTED:To appoint 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." For Corporations ONLY A true copy attest.A true copy attest. CorpoTK^fficer /LLC Manager Signature Corporation Clerk's Signature S), (Print Name)(Print Name) APPLICANTS STATEMENT .□.□□.□ Authorized Signatory LLC/LLP managercorporateprincipal;the:sole proprietor;partner; lAci^or C\vi\~>DRft TvrQf\pi-]<£c^'S Name of the Entity/Corporation of 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: 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; (1) I state that the location and description of the proposed licensed premises are in compliance with state and local laws and regulations; (2) I understand that while the Application is pending,1 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; (3) 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; (4) 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; (5) 1 understand that all statements and representations made become conditions of the license;(6) 1 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; (7) 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 (8) 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. (9) 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. (10) Signature:Date:O Title: he Commonwealth of Massachusetts Alcoholic Beverages Control Commission 95 Fourth Street,Suite 3,Chelsea,MA 02150-2358 www.mass.gov/abcc AMENDMENT-Change of Manager □Change of License Manager 1.BUSINESS ENTITY INFORMATION Municipality ABCC License NumberEntityName 00/1)6 R‘g-OD70<SHarborjXj^er 84^ 2.APPLICATION CONTACT The application contact is the person who should be contacted with any questions regarding this application. Name Title Email Phone >r\e. 3A.MANAGER INFORMATION The individual that has been appointed to manage and control of the licensed business and premises. \zjT1 \Proposed Manager Name 7265)5DateofBirthSSN Residential Address Email Phone Please indicate how many hours per week you intend to be on the licensed premises Last-Approved License Manager5D 3B.CITIZENSHIP/BACKGROUND INFORMATION Yes r No ^Manager must be U.S.citizen If yes,attach one of the following as proof of citizenship US Passport,Voter's Certificate,Birth Certificate or Naturalization Papers.Have you ever been convicted of a state,federal,or military crime?p Yes C No 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. Are you a U.S.Citizen?* Municipality Charge DispositionDate 3C.EMPLOYMENT INFORMATION Please provide your employment history.Attach additional pages,if necessary,utilizing the format below. EmployerEndDatePosition Supervisor NameStartDate (^|i lap 9)i)^Z ^\\&3\5yzD ^-EevN 5oTro Rs-$sWorN -V 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?p yes C No If please fill out the table.Attach additional pages,if necessary,utilizing the format below. Reason for suspension,revocation or cancellationNameofLicenseStateCityDateofAction I hereby swear under the pains and penalties of perjury that the information I have provided in this application is true and accurate: iJRDateManager's Signature .7