The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512
Foreign Professional Limited Liability Company
Annual Report
(General Laws Chapter 156C, Section 48)
_____________________________ Year: ____________________
Federal Identification No.:
(1a) e exact name of the foreign limited liability company:
________________________________________________________________________________________________
(1b) e exact name of the limited liability company as amended:*
________________________________________________________________________________________________
(1c) If different, the name under which it does business in the Commonwealth:
________________________________________________________________________________________________
(2) e jurisdiction where the limited liability company is organized and the date of organization:
________________________________________________________________________________________________
(3a) e professional service to be rendered:
________________________________________________________________________________________________
(3b) e name and address of each member or manager who will render a professional service in the Commonwealth:
regulating board including the provision of liability insurance required by M.G.L. c.156C § 65.
(3c) e limited liability company agrees that each member or manager who will render a service in the Commonwealth is duly
licensed to provide the service and to abide by and be subject to any conditions or limitations established by any applicable
(4) e business address of its principal office:
FP
* If the name of the limited liability company has been amended, attach a certificate evidencing the change issued by an officer or agency
properly authorized in home state.
