Free c156ds933950c11327.indd - Massachusetts

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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 9.33; 950 CMR 113.27)

Articles of Charter Surrender Upon Foreign Non-profit Conversion

FORM MUST BE TYPED

(1) Exact name of corporation: ___________________________________________________________________________

(2) Registered office address: _____________________________________________________________________________ (number, street, city or town, state, zip code) (3) The articles of charter surrender are filed in connection with the conversion of the corporation to a foreign non-profit corporation. (4) The conversion is permitted by the laws of the foreign jurisdiction.

(5) Corporation's new name: _____________________________________________________________________________ New jurisdiction of incorporation: _____________________________________________________________________

(6) The foreign non-profit conversion was duly approved by the shareholders, and where required, by each separate voting group as provided by G.L. Chapter 156D and the articles of organization.

(7) The corporation hereby appoints the Secretary of the Commonwealth as its agent for service of process in any proceeding to enforce the rights of shareholders who exercise appraisal rights in connection with the conversion.

(8) The charter surrender shall be 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 and time 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_________________________________________ , _____________________ . of

P.C.

c156ds933950c11327 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 9.33; 950 CMR 113.27)
I hereby certify that upon examination of these articles of charter surrender, duly submitted to me, it appears that the provisions of the General Laws relative thereto have been complied with, and I hereby approve said articles; and the filing fee in the amount of $______ having been paid, said articles are 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)

Articles of Charter Surrender Upon Foreign Non-profit Conversion

WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth Filing fee: Minimum $250
Examiner

TO BE FILLED IN BY CORPORATION
# A.R.

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.