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Home My WebLink AboutNot Your Average Joes Chanage of Manager 072424 Tire Commmnwealth ni Mossaehuseres Alcoholic Beverages Control Comrrdssion 95 Fourth Sheet,Suite.$Chelsea,MA 02150.2358 w ww,mass.gov/aAcec• If 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:RETA Please make$200.00 payment here:ABCC PAYMENT WESSITF 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) I00239-RS-0070 ENTITY/LICENSEE NAME NOT YOUR AVERAGE JOE'S INC ADDRESS 1793 IYANNOUGH ROAD CITY/TOWN BARNSTABLE STATE MA ZIP CODE 102601 For the following transactions(Check all that apply): EI New License Change of Location Fj Changeof ClassncmnuaVxemezn []Change COjmmte Stivapren.<mmntq Tramferof License O Alteration of Licensed Premises ❑ Change of Ll<enseTypeaeamrrmauraorl ❑ Pledgeaf Collatera,,, mnwseal 0Chan,r&A eager E]Change Corporate Name E)Change Of Category µAAI Al.Mnm<.maal ManagemenUOperatingAgreement Ei Change ofrol Change of0wncosir Interest El sausncepYanSferof5tock/New Stockholder Changeof cars ferectorshLCManag.s 7uLC Members/LLP Partners, Trustees) Oina,j ❑ Changeol THE LOCAL LICENSING AUTHORITY MUST SUBMIT THIS APPLICATION ONCE APPROVED VIA THE E PLACE PORTAL Alcoholic Beverages Control Commission 95 Fourth Street,Suite 3 Chelsea,MA 02150-2358 6111/24,12:14 PM Print Receipt Your Information Payment Receipt 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, guc S. iFu iy. . ?... FILING FEES RETAIL W�00239-RS-0070 820000 S�aAa Total Convenience Fee: $0.35 Date Paid: W1112024 12:14:24 PM EDT Total Amount Paid: $200.35 Payment On Behalf Of Billing Information License Number or Business Name: First Name: 00239-RS-0070 Christine Last Name: Fee Type: MacDonald FILING FEES-RETAIL Address: Not Your Average Joe's City: Quincy State: MA Zip Code: 02169 Email Address: cmacdonald@nyajoes.com https:/M .ncouo,wm/x-press/PrintReceipt.aspx i/1 The Commonwealth of Massachusetts Alcohols Beverages Control Commission 95 Fourth Street,Suite 3, Chelsea,MA 02150-2358 ww n,.mass gowebcc AMENDMENT-Chanee of Manaeer Ej Change of License Manager �NOT BUSINESS ENTITY INFORMATIONEntity Name Municipality ABCC License Number YOUR AVERAGE JOSS INC ARNSTABLE 0239-RS-0070 Z.APPLICATION CONTACT - --— The application contact is the person who should be contacted with any questions regardingthis application. Name Title _ Email Phone Christine MacDonald I I Licensing I Icmacdonald@nyajoes.com I774-213-2949 3A.MANAGER INFORMATION The individual that has been appointed to manage and control of the licensed business and premises. Proposed Manager Namel Moriah Belle Bassett I Date of Birth 05-03-1991 SSN I029-74-4624 Residential Address 20 Wallwind Drive Plymouth MA 02360 Email mbassett@nyajoes.com I Phone I 774-992-2482 Please indicate how many hours per week Last-Approved License Manager' you intend to be on the licensed premises 40+ I David Hamill 38.CITIZENSHIP/BACKGROUND INFORMATION Are you a U.S.Citizen?* QYes ('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? (`Yes NNo 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. J Date Municipality Charge Disposition I 3C. EMPLOYMENT INFORMATION Please provide your employment history.Attach additional pages,if necessary, utilizing the format below. Start Date End Data Position Employer Supervisor Name 2020 present manager Not Your Average Joe's Inc Sara Murtagh 2019 2022 manager BBC Centerville MA 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? (-Yes 6�110 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 I I hereby swear under the ppms ordperafties rfperjury that the informatim 1 have provided in this application is true and accurate: Manager's Signature I / vLGn-H I Date I Cc, l, + , 2q APPLICANT'S STATEMENT 1 (Joseph McGuire the. sole ro rietor;p p partner, El corporate principal; 0 LLC/LLP manager Authorized Signatory of l Not Your Average Joe'a 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 fallowing to be true and accurate: (1) 1 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, (2) 1 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) 1 understand that the licensee will be bound bythe 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) 1 understand that all statements and representations made become conditions of the Incense; (7) 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; (8) 1 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) 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. (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 employyeee�s and contractors,and withholding and remitting of child support. Signature: ovl ,f__— / 1� _ Date: I�.. I LGJ�`l Title. I CEO Y - ENTITY VOTE The Board of Directors or LLC Managers of I Not Your Average Joe's Inc Entity Name duly voted to apply to the Licensing Authority of IBarnstable land the City/Town Commonwealth of Massachusetts Alcoholic Beverages Control Commission on 1 05-01-2024 Date of Meeting For the following transactions(Check all that apply): Q Change of Manager Omer I "VOTED:To authorize (Joseph McGuire 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." 'NOTED:To appoint Moriah Belle Bassett 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 anyway have and exercise if it were a natural person residing in the Commonwealth of Massachusetts." For Carnnrationa ONI V A true copy attest, A true copy �`attest,� `^ Corporate Officer/LLC Manager Signature o oration Clerks Signature Joseph McGuire (Print Name) (Print Name) Cmmnoawea(fh cfMassaahnnatte Alcoholic Beverages Control Commission 95Fo She ;Saito 3 et Clock.,T1A 02150 ✓EAA'AL LOFLZFQ Es¢ CORT R POT IFST FORM CNAIftN1N The Alcoholic Beverages Control Commission("ABCC") has been certitSed by the Criminal History Systems Board to access conviction and pending Criminal Offender Record Information("CORI"). For the purpose of approving each shareholder, owner, licensee or applieam bar mr elmholic beverages lieerre,1 understand that a criminal record check will be conducted on me,presuant t0 the above The information below h co rect in the best Amy knowledge. ABCCLICFNSEINFORMErION AB[[NUrMBER; ` PS' LICENSEE NAME;INot Your Averagelce's Inc I cEg/TOWN: 9amstffile APPLAMPREENFORMAp U TNAME: Rdisett FIRSTNAMF IMonah NIIDOLFNAME'(Belle MAIDEN NAME OR AnFS(EAPPLICABIEI. I L I.EOFRIEFE, IWmehem,MH DATE OF BIRTH' I05-03-1991 SSN: DEN-0146]N ID THEFT INDEX PIN(IF APPIICARI£) MOTHERS MAIDEN NAME: (Greene _—_ ORIVER'SURNSE M:I544093488 STATE LIC ISSUED: IM...aclunatto GENDER. FEMALE mID.T: � WEmM: IZS EYE COL00. Rlue 1 CURRENTAODRESS 20WAIMudDrve CITY/TOWN: Mymcuth STATE:F.A yIP: 02360 FOFM.e.EXEA I1--ruesul-no J CITYYTOWN; Werthdm STATE: .A Z1 P' I8251T I PRINTANUSWN PRINTFD NAME: IMOrIMIN Belle Bassett A"rMaNTAMPLOYEE SICKATUBE: Nagenny FORMATION On this I[/'��A (b efore me,the undersigned notary pubI personally appeared Moriah Bassett 2Dzy (name of dewmeet rgaep,pmved to me tnrpugh satisfaa0ry evidence 0f iaenilficanon,,,which were (personal knowledge tta to W the person whose name is signed 0n the preceding or ached dorumen[ krtbwladgnd to me that(he)(she)signed it voluntarily for its stated puryou. NOTARY pcCTa(abSs llq CAVOI01(yr,W11 �.,T�dgPn°d.UWyd/Y ....�..W ... _ T: _ O:..� .....u...,d.,°".."...,MmPm . NO ! '�p�00tlW `Nr\ sv GOt '.HGT ?AR- . kk.LTfi CYP XAS AC893ETTS ^. HTiD ' K,CR ;I+ P- bvT... E HhSSETT - ttAx 3 . T591 MALF 6i 50 PM Y.CRF[ ERI PART= . :. ➢ irex nn ➢ ansssrr - - SR ➢ G➢ £ ACRJ , YA ' ALGUST 16 � F453 £AYHERlYAR£ uT ' ] ' £ F4ff? Y .:VCIS BR. 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