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P The Commonwealth of Massachusetts (Commonwealth of Massachusetts)

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512
P
Professional Limited Liability Company
Certificate of Organization
(General Laws Chapter 156C, Section 12)
_____________________________
Federal Identification No.:
(1) e exact name of the limited liability company:
________________________________________________________________________________________________
(2) e street address of the office in the commonwealth at which its records will be maintained:
(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, and
attach a certificate of the applicable regulating board that each such member or manager who will render the service in the
Commonwealth is duly licensed:
(3c) e limited liability company agrees to abide by and be subject to any conditions or limitations established by any applicable
regulating board including the provision of liability insurance required by G.L. c.156C § 65.
___________________________________________________________________
(4) Latest date of dissolution, if specified:
(5) e name and street address, of the resident agent in the commonwealth:
ADDRESS NAME
(6) e name and business address, if different from office location, of each manager, if any, and if none, so state:
ADDRESSNAME
(7) e name and business address, if different from office location, of each person in addition to manager(s) authorized to
execute documents filed with the Corporations Division, and at least one person shall be named if there are no managers:
NAME ADDRESS
(8) e name and business address, if different from office location, of each person authorized to execute, acknowledge, deliver
and record any recordable instrument purporting to affect an interest in real property recorded with a registry of deeds or
district office of the land court:
NAME ADDRESS
(9) Additional matters:
________________________________________________________________ Signed by (by at least one authorized signatory):
Consent of resident agent:
__________________________________________________________________________________________________ ,I
resident agent of the above limited liability company, consent to my appointment as resident agent pursuant to G.L. c 156C § 12*
*or attach resident agent’s consent hereto.
COMMONWEALTH OF MASSACHUSETTS
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Professional Limited Liability Company
Certificate of Organization
(General Laws Chapter 156C, Section 12)
to have been filed with me this
_______ having been paid, said application is deemed
I hereby certify that upon examination of this limited liability company certificate,
duly submitted to me, it appears that the provisions of the General Laws relative
thereto have been complied with, and I hereby approve said application; and the
filing fee in the amount of $
________________ day of ________________, 20 _____, at _______a.m./p.m.
time
Effective date:_____________________________________________________
WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth
Filing fee: $500
TO BE FILLED IN BY LIMITED LIABILITY COMPANY
Contact Information:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________
Telephone:
______________________________________________________Email:
Upon filing, a copy of this filing 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.
c156cs12pllccert 10/14/08
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Completed 4 April 2022

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