Foreign Professional Limited Liability Company Application For Registration

FP The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512 Foreign Professional Limited Liability Company Application for Registration (General Laws Chapter 156C, Section 48) Federal Identification No.: _____________________________ (1a) The exact name of the limited liability company: ________________________________________________________________________________________________ (1b) If different, the name under which it proposes to do business in the Commonwealth of Massachusetts: ________________________________________________________________________________________________ (2) The jurisdiction* where the limited liability company was organized: ________________________________________________________________________________________________ (3) The date of organization in that jurisdiction: ______________________________________________________________ (4a) The professional service to be rendered: ________________________________________________________________________________________________ (4b) The name and address of each member or manager who will render a professional service in the Commonwealth, and attach a certificate of the applicable regulating board that each such member or manager who will render the service in the Commonwealth is duly licensed: (4c) The limited liability company agrees to abide by and be subject to any conditions or limitations established by any applicable regulating board including the provision of liability insurance required by G.L. c.156C § 65. (5) The business address of its principal office: American LegalNet, Inc. www.FormsWorkFlow.com (6) The business address of its principal office in the Commonwealth, if any: (7) The name and business address, if different from principal office location, of each manager, if any, and if none, so state: (8) The name and business address of each person authorized to execute, acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property recorded with a registry of deeds or district office of the land court: NAME ADDRESS (9) The name and street address of the resident agent in the Commonwealth: (10) The latest date of dissolution, if specified: ________________________________________________________________ (11) Additional matters: Signed by (by at least one authorized signatory): ________________________________________________________________ , I __________________________________________________________________________________________________ , resident agent of the above limited liability company, consent to my appointment as resident agent pursuant to G.L. c156C § 48 (or attach resident agent's consent hereto). * Attach a certificate of existence or good standing issued by an officer or agency properly authorized in home state. American LegalNet, Inc. www.FormsWorkFlow.com COMMONWEALTH OF MASSACHUSETTS Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 William Francis Galvin Foreign Limited Liability Company Application for Registration (General Laws Chapter 156C, Section 48) I hereby certify that upon examination of this foreign limited liability company application for registration, duly submitted to me, it appears that the provisions of the General Laws have been complied with, and I hereby approve said application; and the filing fee in the amount of $ ______having been paid, said application is deemed to have been filed with me this ____________day of ________________20_____________at ________ am/pm. time WILLIAM FRANCIS GALVIN Secretary of the Commonwealth Filing fee: $500 TO BE FILLED IN BY FOREIGN LIMITED LIABILTY COMPANY 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. c156cs48fpllcregistration 10/14/08 American LegalNet, Inc. www.FormsWorkFlow.com