1. BUSINESS ENTITY INFORMATION
ABCC License NumberEntity Name
Municipality
APPLICATION CONTACT
The application contact is the person who should be contacted with any questions regarding this application.
EmailName
Phone
Title
Please provide a narrative overview of the transaction(s) being applied for.
Last-Approved Corporate Name:
Requested New Corporate Name:
Last-Approved DBA:
Requested New DBA:
2 . CHANGES TO BUSINESS ENITIY INFORMATION
Last-Approved Corporate Structure
Requested New Corporate Structure
LLC, Corporation, Sole Proprietor, etc
Signature: Date:
Title:
DOR Certificate of Good Standing (Req. for Chg of Corp
Name only)
DUA Certificate of Compliance (Req. for Chg of Corp
Name only)
Change of Corporate Name/DBA Application
Vote of the Entity
Payment Receipt
Business Structure Documents
If Sole Proprietor, Business Certificate
If partnership, Partnership Agreement
If corporation or LLC, Articles of Organization
from the Secretary of the Commonwealth
Change of Corporate Name
Change of DBA
DOR Certificate of Good Standing
DUA Certificate of Compliance
Change of Corporate Structure Application
Vote of the Entity
Payment Receipt
Business Structure Documents
Change of Corporate Structure
If Sole Proprietor, Business Certificate
If partnership, Partnership Agreement
If corporation or LLC, Articles of Organization
from the Secretary of the Commonwealth
APPLICATION FOR AMENDMENT-Change of Business Entity Information
2a. Change of Corporate Name
2b. Change of DBA
2c. Change of Corporate Structure
The Commonwealth of Massachusetts
Alcoholic Beverages Control Commission
95 Fourth Street, Suite 3, Chelsea, MA 02150-2358
www.mass.gov/abcc
click to sign
signature
click to edit
APPLICANT'S STATEMENT
I, the: sole proprietor; partner; corporate principal; LLC/LLP manager
Authorized Signatory
of
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) 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;
(2) 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) 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 employees and contractors, and withholding and remitting of child support.
Signature: Date:
Title:
click to sign
signature
click to edit
A true copy attest,
__________________________
Corporate Officer /LLC Manager Signature
For Corporations ONLY
A true copy attest,
__________________________
Corporation Clerk's Signature
CORPORATE VOTE
The Board of Directors or LLC Managers of
duly voted to apply to the Licensing Authority of and the
Commonwealth of Massachusetts Alcoholic Beverages Control Commission on
“VOTED: To authorize
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.”
City/Town
Name of Person
Date of Meeting
Entity Name
For the following transactions (Check all that apply):
Other
Change Corporate Structure (i.e. Corp / LLC)
Change of DBA
Change Corporate Name
(Print Name)
__________________________
(Print Name)
__________________________
RETAIL ALCOHOLIC BEVERAGES LICENSE APPLICATION
MONETARY TRANSMITTAL FORM
APPLICATION SHOULD BE COMPLETED ON-LINE, PRINTED, SIGNED, AND SUBMITTED TO THE LOCAL
LICENSING AUTHORITY.
ABCC LICENSE NUMBER (IF AN EXISTING LICENSEE, CAN BE OBTAINED FROM THE CITY)
ENTITY/ LICENSEE NAME
ADDRESS
CITY/TOWN STATE ZIP CODE
For the following transactions (Check all that apply):
THE LOCAL LICENSING AUTHORITY MUST MAIL THIS
TRANSMITTAL FORM ALONG WITH
COMPLETED APPLICATION, AND SUPPORTING DOCUMENTS TO:
APPLICATION FOR AMENDMENT-Change of Business Entity Information
Change of Class (i.e. Annual / Seasonal)
New License
Transfer of License
Issuance/Transfer of Stock/New Stockholder
Alteration of Licensed Premises
Management/Operating Agreement Change of Manager Change Corporate Name
Change of License Type (i.e. club / restaurant)
Change of DBA
Pledge of Collateral (i.e. License/Stock)
Change of Officers/
Directors/LLC Managers
Change of Category (i.e. All Alcohol/Wine, Malt)
Change Corporate Structure (i.e. Corp / LLC)
Change of Hours
Other
Change of Location
Change of Ownership Interest
(LLC Members/ LLP Partners,
Trustees)
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
The Commonwealth of Massachusetts
Alcoholic Beverages Control Commission
95 Fourth Street, Suite 3, Chelsea, MA 02150-2358
www.mass.gov/abcc
Alcoholic Beverages Control Commission
95 Fourth Street, Suite 3
Chelsea, MA 02150-2358