The Commonwealth of Massachusetts
                                           William Francis Galvin
D
                                           Secretary of the Commonwealth
 One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512

 Limited Liability Company Annual Report
                                      (General Laws Chapter 156C, Section 12)

Federal Identification No.: _____________________________                                         Year: ____________________

(1a) The exact name of the limited liability company:

  ________________________________________________________________________________________________

(1b) The exact name of the limited liability company as amended:

  ________________________________________________________________________________________________

(2a) Location of its principal office:

  ________________________________________________________________________________________________

(2b) The street address of the office in the commonwealth at which its records will be maintained:

(3)  The general character of the business:

  ________________________________________________________________________________________________

(4)  Latest date of dissolution, if specified: ___________________________________________________________________

(5)  The name and street address of the resident agent in the commonwealth:

(6)  The name and business address of each manager, if any:

(7)  The name and business address of the person(s) 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:

(8)  The name and business address of the person(s) authorized to execute, acknowledge, deliver and record any recordable 
instrument purporting to affect an interest in real property. 

(9)  Additional matters:

Signed by (by at least one authorized signatory): ________________________________________________________________

COMMONWEALTH OF MASSACHUSETTS

William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512

Limited Liability Company Annual Report
(General Laws Chapter 156C, Section 12)

I hereby certify that upon examination of this limited liability company annual 
report, 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 $  _______  having been paid, said application 
is deemed to have been filed with me this
________________ 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.

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