Massachusetts > Statewide > Alcoholic Beverages Commission
Offer In Compromise In Lieu Of Suspension - Massachusetts
| Offer In Compromise In Lieu Of Suspension 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 OFFER IN COMPROMISE IN LIEU OF SUSPENSION 1._______________________________________________ Name of Licensee (including dba, if any) 2._______________________________________________ Street Address of Premises City/Town 3. ______________________________________________ Mailing Address (if different from line 2) 4. ______________________________________________ Type of License 5. The above licensee offers to the A.B.C.C. a fine in lieu of the Commissions recent suspension of this license. The licensee certifies that this offer is computed according to the formula set forth in MGL Chapter 138, Section 23. If this offer is accepted, the licensee waives all rights to appeal and wai ves judicial review of the Commissions decision. 5a. Violation date____________________ 5b. Number of suspension days_________ 6. The amounts entered on lines 7 and 8 may be from either the twelve months immediately preceding the date of the violation or, for licensees that have been in business for more than one year, from the licensees most recent full fiscal (income tax) year. State the period covered by the figures on lines 7 and 8: ______________________________________________ 7. Gross annual receipts from sale of alcoholic beverages ______________ 8. Invoiced annual cost of goods sold (alcoholic beverages only) ______________ 9. Gross Annual Alcoholic Beverage Profit (Line 7 minus line 8) ______________ 10. Annual days of operation (7 day licensees enter 365, 6 Day licensees enter 313, special and others enter actual days open during the 1 American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 year preceding the violation date) ______________ 11. Per diem gross alcoholic beverage profit (divide line 9 by line 10) ______________ (continue on other side) Enter amount from line 11 ______________ 12. Enter 50% of amount shown on line 11 ______________ 13. Per diem fine (enter greater of line 12 or $40.00) ______________ 14. Days of suspension (from line 5b) ______________ 15. OFFER IN COMPROMISE (line 13 multiplied by line 14) ______________ Signed under the penalties of perjury, _________________________________________________________________ Licensee (If licensee is a Date Corporation, Manager of Record) ACCOUNTANTS CERTIFICATION I certify that I have examined the books and records of the above licens ee and that the figures contained in the petition are correct. ________________________________________________________________________ ______ Licensed Public Accountant Mass. Lic. No. Date ________________________________________________________________________ ______ Licensed Public Accountant (Print Name Clearly) ________________________________________________________________________ ______ Accountant Address NOTICE: THIS OFFER MUST BE DELIVERED TO THE ABCC WITHIN TWENTY DAYS OF RECEIPT OF THE COMMISSIONS DECISION AND MUST BE ACCOMPANIED BY A CERTIFIED OR BANK CHECK FOR THE FULL AMOUNT OF THE OFFER PAYABLE TO THE ALCOHOLIC BEVERAGES CONTROL COMMISSION. THE OFFER MUST BE SIGNED BY A MASSACHUSETTS LICENSED ACCOUNTANT. REV.5/02 2 American LegalNet, Inc. www.USCourtForms.com
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