Application For Revival (Nonprofit)

IDENTIFICATION NO. _____________________ Filing Fee: $40.00 Examiner The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512 (General Laws, Chapter 180, Section 10C) APPLICATION FOR REVIVAL 1. Exact name of corporation is: 2. Name of applicant is: 3. Address of applicant is: 4. State fully the applicant's relationship to, or interest in, the corporation: 5. Date of dissolution or revocation of charter of the corporation is: 6. The corporation was dissolved or the charter was revoked under the provisions of General Laws, Chapter 180, Section ____________. 7. Describe fully the circumstances leading to the dissolution or revocation: P.C. American LegalNet, Inc. www.FormsWorkFlow.com 180arev 2/26/16 8. Describe fully the activities, if any, of the corporation since dissolution or revocation of the charter: 9. Does the applicant seek a limited or general revival? If limited, state fully the reason(s) therefore, and period of time (not exceeding one year) sought for the revival: SIGNED UNDER THE PENALTIES OF PERJURY, this __________ day of________________________________ , 20 ___________, _________________________________________________________________________________________, Signature of Applicant. American LegalNet, Inc. www.FormsWorkFlow.com THE COMMONWEALTH OF MASSACHUSETTS (General Laws, Chapter 180, Section 10C) APPLICATION FOR REVIVAL I hereby approve the within Application for Revival 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 ______ . The corporation revived as provided herein. WILLIAM FRANCIS GALVIN Secretary of the Commonwealth TO BE FILLED IN BY CORPORATION Contact information: _________________________________________________________ _________________________________________________________ _________________________________________________________ Telephone: _________________________________________________ Email: __________________________________________________________ A copy this filing will be available on-line at www.state.ma.us/sec/cor once the document is filed. American LegalNet, Inc. www.FormsWorkFlow.com