____________________________________ ______________ _______ _________________
(City/Town) (State) (Zip) (Country)
Daytime telephone number _________________ Email address _______________________
Checks/Money order only, made payable to: Commonwealth of Massachusetts
Number of documents _______ x $6.00 per document = Total Due ___________
METHOD TO RETURN DOCUMENTS
Check the box of the method below by which to return the documents; if nothing is checked your
order will be available in the office for pick up.
First Class Mail (self-addressed stamped envelope required)
Express Mail (prepaid label & envelope required)
Pick up order in the office
Mail or hand deliver this completed form along with the payment and documents to be
authenticated to one of the following offices:
Secretary of the Commonwealth Secretary of the Commonwealth Secretary of the Commonwealth
Commissions Section 436 Dwight Street, Room 102 218 South Main Street, Suite 206
One Ashburton Place, Room 1719 Springfield, MA 01103 Fall River, MA 02721
Boston, MA 02108 (413) 784-1376 (508) 646-1374
Any more than three (3) documents hand delivered must be left overnight and picked up the
next business day, no exceptions.
For more information, please visit www.sec.state.ma.us/pre or contact the Commissions Section by
email at: firstname.lastname@example.org or by phone at: (617) 727-2836.