Massachusetts > Statewide > Alcoholic Beverages Commission
Retail Alcoholic Beverages License Application - Massachusetts
| Retail Alcoholic Beverages License Application Form. This is a Massachusetts form and can be used in Alcoholic Beverages Commission Statewide . |
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The Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston, MA 02114 www.mass.gov/abcc RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION MONETARY TRANSMITTAL FORM APPLICATION SHOULD BE COMPLETED ON-LINE, PRINTED, SIGNED, AND SUBMITTED TO THE LOCAL LICENSING AUTHORITY. ECRT CODE: RETA CHECK PAYABLE TO ABCC OR COMMONWEALTH OF MA: CHECK NUMBER IF USED EPAY, CONFIRMATION NUMBER $200.00 (CHECK MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL) A.B.C.C. LICENSE NUMBER (IF AN EXISTING LICENSEE, CAN BE OBTAINED FROM THE CITY) LICENSEE NAME ADDRESS CITY/TOWN TRANSACTION TYPE (Please check all relevant transactions): Alteration of Licensed Premises Cordials/Liqueurs Permit Issuance of Stock Management/Operating Agreement More than (3) §15 STATE ZIP CODE New Officer/Director New Stockholder Transfer of License Transfer of Stock Wine & Malt to All Alcohol 6-Day to 7-Day License Change Corporate Name Change of License Type Pledge of Stock Pledge of License Seasonal to Annual Change of Location Change of Manager Other New License THE LOCAL LICENSING AUTHORITY MUST MAIL THIS TRANSMITTAL FORM ALONG WITH THE CHECK, COMPLETED APPLICATION, AND SUPPORTING DOCUMENTS TO: ALCOHOLIC BEVERAGES CONTROL COMMISSION P. O. BOX 3396 BOSTON, MA 02241-3396 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FOR RETAIL ALCOHOLIC BEVERAGE LICENSE City/Town 1. LICENSEE INFORMATION: A. Legal Name/Entity of Applicant:(Corporation, LLC or Individual) B. Business Name (if different) : D. ABCC License Number (for existing licenses only) : E.Address of Licensed Premises: F. Business Phone: H. Email: J.Mailing address (If different from E.): C. Manager of Record: City/Town: G. Cell Phone: I. Website: City/Town: State: Zip: State: Zip: 2. TRANSACTION: New License Transfer of License New Officer/Director New Stockholder Transfer of Stock Issuance of Stock Pledge of Stock Pledge of License Management/Operating Agreement The following transactions must be processed as new licenses: Seasonal to Annual (6) Day to (7)-Day License Wine & Malt to All Alcohol IMPORTANT ATTACHMENTS (1): The applicant must attach a vote of the entity authorizing all requested transactions, including the appointment of a Manager of Record or principal representative. 3. TYPE OF LICENSE: §12 Restaurant §12 General On-Premises §12 Hotel §12 Club §12 Veterans Club §15 Package Store §12 Tavern (No Sundays) 4. LICENSE CATEGORY: All Alcoholic Beverages Wine & Malt Beverages Only Wine or Malt Only Wine & Malt Beverages with Cordials/Liqueurs Permit 5. LICENSE CLASS: Annual Seasonal American LegalNet, Inc. www.FormsWorkFlow.com 6. CONTACT PERSON CONCERNING THIS APPLICATION (ATTORNEY IF APPLICABLE) NAME: ADDRESS: CITY/TOWN: CONTACT PHONE NUMBER: STATE: FAX NUMBER: ZIP CODE: EMAIL: 7. DESCRIPTION OF PREMISES: Please provide a complete description of the premises to be licensed. Please note that this must be identical to the description on the Form 43. Total Square Footage: Occupancy Number: Number of Entrances: Seating Capacity: Number of Exits: IMPORTANT ATTACHMENTS (2): The applicant must attach a floor plan with dimensions and square footage for each floor & room. 8. OCCUPANCY OF PREMISES: By what right does the applicant have possession and/or legal occupancy of the premises? IMPORTANT ATTACHMENTS (3): The applicant must submit a copy of the final lease or documents evidencing a legal right to occupy the premises. Please select Other: Landlord is a(n): Name: Address: Please Select Other: Phone: City/Town: Ending Date Options/Extensions at: Years Each Per Month State: Zip: Initial Lease Term: Beginning Date Renewal Term: Rent: Per Year Rent: Do the terms of the lease or other arrangement require payments to the Landlord based on a percentage of the alcohol sales? Yes No IMPORTANT ATTACHMENTS( 4): 1. If yes, the Landlord is deemed a person or entity with a financial or beneficial interest in this license. Each individual with an ownership interest with the Landlord must be disclosed in §10 and must submit a completed Personal Information Form attached to this application. 2. Entity formation documents for the Landlord entity must accompany the application to confirm the individuals disclosed. 3. If the principals of the applicant corporation or LLC have created a separate corporation or LLC to hold the real estate, the applicant must still provide a lease between the two entities. American LegalNet, Inc. www.FormsWorkFlow.com 9. LICENSE STRUCTURE: The Applicant is a(n): Please select Other : If the applicant is a Corporation or LLC, complete the following: State of Incorporation/Organization: Is the Corporation publicly traded? Yes No Date of Incorporation/Organization: 10. INTERESTS IN THIS LICENSE: List all individuals involved in the entity (e.g. corporate stockholders, directors, officers and LLC members and managers) and any person or entity with a direct or indirect, beneficial or financial interest in this license (e.g. landlord with a percentage rent based on alcohol sales). IMPORTANT ATTACHMENTS (5): A. All individuals or entities listed below are required to complete a Personal Information Form. B. All shareholders, LLC members or other individuals with any ownership in this license must complete a CORI Release Form. Name All Titles and Positions Specific # of Stock or % Owned Other Beneficial Interest *If additional space is needed, please use last page. 11. EXISTING INTEREST IN OTHER LICENSES: Does any individual listed in §10 have any direct or indirect, beneficial or financial interest in any other license to sell alcoholic No beverages? Yes If yes, list said interest below: Name License Type Please Select Please Select Please Select Please Select Please Select Please Select Please Select *If additional space is needed, please use last page. Licensee Name & Address American LegalNet, Inc. www.FormsWorkFlow.com 12. PREVIOUSLY HELD INTERESTS IN OTHER LICENSES: Has any individual listed in §10 who has a direct or indirect beneficial interest in this license ever held a direct or indirect, beneficial or No financial interest in a license to sell alcoholic beverages, which is not presently held? Yes If yes, list said interest below: Name Licensee Name & Address Date Reason Terminated Please Select Please Select Please Select 13. DISCLOSURE OF LICENSE DISIPLINARY ACTION: Have any of the disclosed licenses to sell alcoholic beverages listed in §11 and/or §12 ever been sus
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