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9. LICENSE STRUCTURE: <br /> The Applicant is a(n): Corporation Other <br /> If the applicant is a Corporation or LLC, complete the following: <br /> Date of Incorporation/Organization: July 18, 2008 <br /> State of Incorporation/Organization: MA <br /> Is the Corporation publicly traded? Yes © No XX <br /> 10. INTERESTS IN THIS LICENSE: <br /> 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 <br /> direct or indirect,beneficial or financial interest in this license. <br /> IMPORTANT ATTACHMENTS(4): <br /> A.All individuals or entities listed below are required to complete a Personal Information Form. <br /> B.All shareholders,LLC members or other individuals with any ownership in this license must complete a CORI Release Form(unless they are a landlord entity) <br /> -7 Name All Titles and Positions Specific%Owned Other Beneficial Interest <br /> John J. Pelletier Director 51.0% <br /> .David M. Pelletier Director 24.4% <br /> E. Stanton Bagley Treasurer 20.0% <br /> Larry A.Cates Director 4.6% <br /> Hugo E. Marin President <br /> Mario Mancini Chief Financial Officer <br /> Ayushi, LLC Landlord <br /> *If additional space is needed, please use last page. <br /> 11. EXISTING INTEREST IN OTHER LICENSES: <br /> Does any individual listed in §10 have any direct or indirect, beneficial or financial interest in any other license to sell alcoholic <br /> beverages? Yes ©X No © If yes, list said interest below: <br /> Name License Type F <br /> Licensee Name&Address <br /> Please Select 1 <br /> Please Select <br /> Please Select <br /> Please Select <br /> Please Select <br /> Please Select <br /> *If additional space is needed, please use last page. <br />