PDF document
- 1 -
F          The Commonwealth of Massachusetts
                                                   William Francis Galvin
                                                   Secretary of the Commonwealth
FPC
                              One Ashburton Place, Boston, Massachusetts 02108-1512

     FORM MUST BE TYPED                            Foreign Corporation                                 FORM MUST BE TYPED
                                                   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 corporation’s 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.*

     * Or attach registered agent’s consent hereto.

P.C.                                                                                                                     c156ds1503950c11348 01/13/05



- 2 -
(6)  Fiscal year end: _____________________________________________________________________________________
                         (month, day)

(7)  Brief description of the corporation’s 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.

Th  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:  _________________________________________________________________________



- 3 -
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                                     ,  _____________________.



- 4 -
              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 fi ling fee in the amount 
             of $______ having been paid, said certifi cate is deemed to have been fi 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

Examiner                                                                    Filing fee: $400

Name approval
                            TO BE FILLED IN BY CORPORATION
                                                                            Contact Information:
C
             ___________________________________________________________
M
             ___________________________________________________________

             ___________________________________________________________

             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.






PDF file checksum: 2280700262

(Plugin #1/9.12/13.0)