Free Certificate of Resignation of Director or Officer  - Massachusetts

D 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 8.45; 950 CMR 113.17)

Certificate of Resignation of Director or Officer

FORM MUST BE TYPED

(1) Exact name of the corporation: _________________________________________________________________________

(2) Registered office address: _____________________________________________________________________________ (number, street, city or town, state, zip code) I, _____________________________________________________________________________________ certify as follows: (name of individual) (3) The corporation has failed, or refused, to file a statement of change in officers and directors within 30 days following a change in directors or officers.

(4) The change in the directors and/or officers is as follows:

It is further certified that a copy of this certificate has been delivered to the corporation or has been mailed to the principal office of the corporation, postage prepaid.

SIGNED UNDER THE PENALTIES OF PERJURY, ____________________________________________________________________________________________________ , (check appropriate box) Director involved in the change, Officer involved in the change, Personal representative of any deceased director or officer involved in the change,

on this ___________________________day of ___________________________________________, _________________ .

P.C.

c156ds845950c11317 07/19/05

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

William Francis Galvin

(General Laws Chapter 156D, Section 8.45; 950 CMR 113.17)
I hereby certify that upon examination of this certificate of change or resignation, duly submitted to me, it appears that the provisions of the General Laws relative thereto have been complied with, and I hereby approve said certificate; and the filing fee in the amount of $______ having been paid, said certificate 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)

Certificate of Resignation of Director or Officer

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.