Fill and Sign the 12 Licensepermit Workform

7.12 License/Permit Workform Reviewer: __________ Client/Matter Number: _________Date: _______________ LICENSE/PERMIT WORKFORM [to be completed for each required license or permit] Issuer of License or Permit: _________________________________ Purpose of License or Permit: _________________________________ Core or Ancillary to Target Company Business? _____________________________________________________________ Name of License/Permit and Description of Authority to Which it Relates: _______________________________________________________ ______________________________________________________________ ______________________________________________________________ Holder (if other than target company, explain relationship to target):_________________________________________________________ ______________________________________________________________ Effective Date: _______________________________________________ Expiration Date: ______________________________________________ Summary of Key Provisions ofLicense/Permit (briefly summarize the substance of the document): ____________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Fee (if any): $ _______________ Due Date for Next Payment (if Recurring): _______________________ Remaining Financial Obligations Through Expiration Data: $ _______ Renewel Procedure: _____________________________________________ _______________________________________________________________ _______________________________________________________________ Transfer/Assignment: Assignable by Permit Holder?: _____ Yes _____ No If "Yes," Describe: _______________________________________ __________________________________________________________ __________________________________________________________ Is Assignment by Operation of Law Prohibited (Such as Change Of Control)?: _____ Yes _____ No If "Yes," Describe: _______________________________________ __________________________________________________________ __________________________________________________________ Does Any Change of Management Affect Permit Validity?: _____ Yes _____ No If "Yes," Describe: _______________________________________ __________________________________________________________ __________________________________________________________ If consent will be required for the contemplated transaction, describe the procedure prescribed for obtaining such consent (include any notice requirement, fee, name of contact party or other material information):__________________________________________________ _______________________________________________________________ _______________________________________________________________ Any other provisions that might impede the contemplated transaction:__________________________________________________________ _______________________________________________________________ _______________________________________________________________ Additional Comments or Issues: _________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________