The Commonwealth of Massachusetts
Alcoholic Beverages Control Commission
239 Causeway Street
Boston, MA 02114
www.mass.gov/abcc
LICENSEE NAME:
ABCC LICENSE NUMBER:
LICENSEE DOING BUSINESS:
CITY/TOWN:
ADDRESS:
CITY/TOWN: STATE ZIP CODE
MANAGER: CATEGORY:
CONTACT EMAIL:
CONTACT NUMBER :
TYPE OF LICENSE:
I hereby certify and swear under penalties of perjury that:
1. the renewed license will be of the same type for the same premises now licensed;
2. the licensee has complied with all laws of the Commonwealth relating to taxes; and
3. the premises are now open for business (If not explain below)
DESCRIPTION OF PREMISES:
OFF-PREMISES LICENSE RENEWAL APPLICATION
APPLICATION FOR RENEWAL:
LICENSE FOR:
2016
DATE:
SIGNED BY
________________________________________
Individual, Partner or Authorized Corporate Officer
EMPLOYER IDENTIFICATION NUMBER:
(Note: NOT Individual Social Security Number)
Please Check Below:
LOCAL LICENSING AUTHORITY By:
APPROVED:
DISAPPROVED:
(If disapproved explain)
APPLICATION FOR RENEWAL MUST BE FILED BY LICENSEES DURING THE MONTH OF NOVEMBER (M.G.L. c. 138 $16A)
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