FORM MUST BE TYPED FORM MUST BE TYPED
The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
c156ds1503950c11348 01/13/05
P.C.
* Or attach registered agent’s consent hereto.
F
FPC
Foreign Corporation
Certifi cate of Registration
(General Laws, Chapter 156D, Section 15.03; 950 CMR 113.48)
(1) Exact name of the corporation, including any words or abbreviations indicating incorporation:
(2) Name under which the corporation will transact business in the commonwealth that satisfi es the requirements of G.L. Chap-
ter 156D, Section 15.06:
If applicable, please attach:
an agreement to refrain from use of the unavailable name in the commonwealth; and
a copy of the doing business certifi cate fi led in the city or town where it maintains its registered offi ce; and
a copy of the resolution of the corporations board of directors, certifi ed by its secretary, the name under which the corpora-
tion will transact business in the commonwealth pursuant to 950 CMR 113.50(4).
(3) Jurisdiction of incorporation:
__________________________________________________________________________
Date of incorporation:
______________________________
Duration if not perpetual:
____________________________
(month, day, year)
(4) Street address of principal offi ce:
_______________________________________________________________________
(number, street, city or town, state, zip code)
(5) Street address of registered offi ce in the commonwealth:
_____________________________________________________
(number, street, city or town, state, zip code)
Name of registered agent in the commonwealth at the above address: _____________________________________
I,
_________________________________________________________________________________________________
registered agent of the above corporation consent to my appointment as registered agent pursuant to G. L. Chapter 156D, Section
5.02.*
(6) Fiscal year end:
_____________________________________________________________________________________
(month, day)
(7) Brief description of the corporations activities to be conducted in the commonwealth:
(8) Names and business addresses of its current offi cers and directors:
NAME BUSINESS ADDRESS
President:
Vice-president:
Treasurer:
Secretary:
Assistant secretary:
Director(s):
Attach certifi cate of legal existence or a certifi cate of good standing issued by an offi cer or agency properly authorized in the
jurisdiction of organization. If the certifi cate is in a foreign language, a translation thereof under oath of the translator shall be
attached.
is certifi cate is eff ective at the time and on the date approved by the Division, unless a later eff ective date not more than 90 days
from the date of fi ling is specifi ed:
_________________________________________________________________________
Signed by:
___________________________________________________________________________________________
,
(signature of authorized individual)
®
Chairman of the board of directors,
®
President,
®
Other offi cer,
®
Court-appointed fi duciary,
on this
_________________________
day of
_________________________________________
day of_________________________________________day of
,
_____________________
.
Examiner
Name approval
C
M
COMMONWEALTH OF MASSACHUSETTS
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Foreign Corporation
Certifi cate of Registration
(General Laws, Chapter 156D, Section 15.03; 950 CMR 113.48)
I hereby certify that upon examination of this foreign corporation certifi cate, duly submit-
ted to me, it appears that the provisions of the General Laws relative thereto have been
complied with, and I hereby approve said certifi cate; and the ling fee in the amount
of $______ having been paid, said certifi cate is deemed to have been led with me this
_____________
day of
_____________
day of _____________day of
, 20
______
, at
_______
a.m./p.m.
time
Eff ective date:
_____________________________________________________
(must be within 90 days of date submitted)
WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth
Filing fee: $400
TO BE FILLED IN BY CORPORATION
Contact Information:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Telephone:
___________________________________________________
Email:
______________________________________________________
Upon fi ling, a copy of this fi ling will be available at www.sec.state.ma.us/cor.
If the document is rejected, a copy of the rejection sheet and rejected document will
be available in the rejected queue.