Statement Of Change Of Registered Office Address By Registered Agent

D F The Commonwealth of Massachusetts William Francis Galvin PC Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 FORM MUST BE TYPED Statement of Change of Registered FORM MUST BE TYPED O ce Address by Registered Agent (General Laws Chapter 156D, Section 5.02 and Section 15.08; 950 CMR 113.22) Name of registered agent: ________________________________________________________________________________ Exact name of corporation(s): _____________________________________________________________________________ Current registered o ce address: __________________________________________________________________________ (number, street, city or town, state, zip code) New registered o ce address: _____________________________________________________________________________ (number, street, city or town, state, zip code) h e street address of the registered o ce of the corporation and the business address of the registered agent are identical as re- quired by G.L. Chapter 156D, Section 5.02 and Section 15.08. It is further certi? ed that each corporation has been noti? ed in writing of this change as required by G. L. Chapter 156D, Section 5.02 and Section 15.08. h is certi? cate is e ) ective at the time and on the date approved by the Division, unless a later e ) ective date not more than 90 days from the date of ? ling is speci? ed: _________________________________________________________________________ Signed by: ___________________________________________________________________________________________, (signature of registered agent) on this ___________________________________day of ______________________________, ______________________. American LegalNet, Inc. www.USCourtForms.com c156ds502s150895011322 01/13/05<<<<<<<<<********>>>>>>>>>>>>> 2 COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Statement of Change of Registered O ce Address by Registered Agent (General Laws Chapter 156D, Section 5.02 and Section 15.08; 950 CMR 113.22) I hereby certify that upon examination of this certi? cate of change, duly submitted to me, it appears that the provisions of the General Laws to the organization of corporations have been complied with, and I hereby approve said statement; and the ? ling fee in the amount of $______ having been paid, said statement is deemed to have been ? led with me this ________day of _________20 at _____a.m./p.m. time E ) ective date: _________________________________________________ (must be within 90 days of date submitted) WILLIAM FRANCIS GALVIN Secretary of the Commonwealth Filing fee: $25 for paper or fax ? lings. No fee if ? led electronically. TO BE FILLED IN BY CORPORATION Contact Information: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Telephone: ___________________________________________________ Email: ______________________________________________________ Upon ? ling, a copy of this ? ling 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. American LegalNet, Inc. www.USCourtForms.com