Free c156as17950c10512 - Massachusetts

FPC

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 156A, Section 17; 950 CMR 105.12)

Exhibit to Foreign Professional Corporation Certificate

FORM MUST BE TYPED

(1) Exact name of the corporation: ________________________________________________________________________

(2) Description of professional services to be rendered in the commonwealth: ________________________________________________________________________________________________

(3) Names and residential addresses of all shareholders, directors, officers and employees, and designations of which shall render professional service(s) in the commonwealth: NAME President: Vice-president: Treasurer: Secretary: Assistant secretary: Director(s): RESIDENTIAL ADDRESS PROFESSIONAL SERVICE(S)

Shareholder(s):

Employee(s):

P.C.

c156as17950c10512 12/30/04

(4) A majority of directors and all officers, except the treasurer, clerk, secretary and any assistant treasurer, assistant clerk and/or assistant secretary, are natural persons who are licensed in a state or territory of the United States or the District of Columbia to render professional services authorized by the corporation's articles of organization (5) All shareholders of the professional corporation are natural persons who are licensed in a state or territory of the United States or the District of Columbia to render professional services authorized by the corporation's articles of organization, or are general partnerships comprised solely of such persons, or are professional corporations authorized to render such professional services.

(6) A certificate by the appropriate regulatory board or boards, showing that the persons required to be licensed in the commonwealth are so licensed, must be attached. (7) Every foreign professional corporation shall be subject to the relevant sections of Part 15 of G.L. Chapter 156D, except as otherwise provided in G.L. Chapter 156A.

(7) A certificate of legal existence or a certificate of good standing, issued by an officer or agency properly authorized in the jurisdiction of organization, must also be attached. If the certificate is in a foreign language, a translation thereof under oath of the translator shall be attached.

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

on this _________________________ day of_________________________________________ , _____________________ . of