Free 112crgbd - Massachusetts

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

FORM MUST BE TYPED

Certificate by Regulatory Board**
(General Laws, Chapter 112 or 221)

FORM MUST BE TYPED

In compliance with General Laws, Chapter 156A, Section 7, the __________________________________________________________ (Exact name of board) hereby certifies that in connection with the incorporation of ____________________________________________________________ , (Exact name of corporation) a professional corporation formed to render ___________________________________________________________________ services, (Type of professional service to be rendered) the below listed incorporators, officers, directors, and shareholders are duly licensed or admitted to practice the profession listed above. INCORPORATORS RESIDENTIAL ADDRESS

OFFICERS

RESIDENTIAL ADDRESS

DIRECTORS

RESIDENTIAL ADDRESS

SHAREHOLDERS

RESIDENTIAL ADDRESS

SIGNED this _______________________________ day of _____________________________________________ , 20 __________ , by _________________________________________________________________________________________ , *Chairman / *Clerk.
*Delete the inapplicable word. **Certain regulatory boards may require a fee for the issuance of this certificate.
112crgbd 7/29/04