Free c156ds401s1506c110s5950c11318.indd - Massachusetts

F FPC

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

FORM MUST BE TYPED

DBA ATTACHMENT FORM MUST BE TYPED (General Laws Chapter 156D, Section 4.01, Section 15.06; Chapter 110, Section 5; 950 CMR 113.18)

Exact name of corporation: ______________________________________________________________________________

State of incorporation: __________________________________________________________________________________

This corporation agrees not to do business in Massachusetts under the above name while use of the name is prohibited by G. L. Chapter 156D, Section 4.01 and/or G. L. Chapter 156D, Section 15.06 where applicable to foreign corporations, or where the name is reserved in accordance with G.L. Chapter 156D, Section 4.02.

Name corporation will use in the commonwealth: _____________________________________________________________

Signed by: ___________________________________________________________________________________________ , (signature of authorized individual) ® Chairman of the board of directors, ® President, ® Other officer, ® Court-appointed fiduciary,

on this _________________________ day of_________________________________________ , _____________________ .

c156ds401s1506c110s5950c11318 12/30/04