Free c156ds502s1508950c11321.indd - Massachusetts

DF PC

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

FORM MUST BE TYPED

(General Laws Chapter 156D, Section 5.02 and Section 15.08; 950 CMR 113.21)
Exact name of corporation(s):_____________________________________________________________________________ Current registered office address: __________________________________________________________________________ (number, street, city or town, state, zip code) New registered office address: _____________________________________________________________________________ (number, street, city or town, state, zip code) Current registered agent: ________________________________________________________________________________ (name of current registered agent) Registered agent will: (check appropriate box) ® change to ____________________________________________________________________________________ . (name of new registered agent) ® remain the same. The street address of the registered office of the corporation and the business address of the registered agent are identical, as required by G. L. Chapter 156D, Section 5.02. This certificate is effective at the time and on the date approved by the Division, unless a later effective date not more than 90 days from the date of filing is specified: _________________________________________________________________________ Signed by: ___________________________________________________________________________________________ , (signature of authorized individual) ® Chairman of the board of directors, ® President, ® Other officer, ® Court-appointed fiduciary, on this ___________________________________ day of ______________________________, ______________________ .

Statement of Change of Registered Agent/Registered Office

FORM MUST BE TYPED

Consent of registered agent:

*or attach registered agent's consent hereto.
P.C.

I, __________________________________________________________________________________ , registered agent of the above corporation, consent to my appointment as registered agent pursuant to G.L. Chapter 156D, Section 5.02.*

c156ds502s1508950c11321 01/13/05

COMMONWEALTH OF MASSACHUSETTS
Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512

William Francis Galvin

(General Laws Chapter 156D, Section 5.02 and Section 15.08; 950 CMR 113.21)

Statement of Change of Registered Agent/Registered Office

I hereby certify that upon examination of this certificate of change, duly submitted to me, it appears that the provisions of the General Laws to the organization of corporations have been complied with, and I hereby approve said statement; and the filing fee in the amount of $______ having been paid, said statement is deemed to have been filed with me this ________ day of _________ 20 at _____ a.m./p.m. time Effective date: _________________________________________________ (must be within 90 days of date submitted)

WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth

Filing fee: $25 for paper or fax filings. No fee if filed electronically.

TO BE FILLED IN BY CORPORATION
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.