Application For Reinstatement Of Authority To Transact Business

F The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth FPC One Ashburton Place, Boston, Massachusetts 02108-1512 FORM MUST BE TYPED Application for Reinstatement FORM MUST BE TYPED of Authority to Transact Business (General Laws Chapter 156D, Section 15.32; 950 CMR 113.56) (1) Exact name of corporation: ___________________________________________________________________________ (2) E ) ective date of revocation: __________________________________________________________________________ (month, day, year) (3) h e name of the corporation satis? es the requirements of G.L. Chapter 156D, Section 4.01 and Section 15.06. (4) h e grounds for revocation: (check appropriate box) did not exist. have been eliminated. (5) h e following information is required to be included in the foreign corporation certi? cate of registration pursuant to G.L. Chapter 156D, Section 15.03: (a) Exact name of the corporation, including any words or abbreviations indicating incorporation: ________________________________________________________________________________________________ (b) Name under which the corporation will transact business in the commonwealth that satis? es the requirements of G.L. Chapter 156D, Section 15.06: ______________________________________________________________________ If applicable, please attach: an agreement to refrain from use of the unavailable name in the commonwealth; and a copy of the doing business certi? cate ? led in the city or town where it maintains its registered o * ce; and a copy of the resolution of the corporations board of directors, certi? ed by its secretary, the name under which the corpora- tion will transact business In the commonwealth pursuant to 950 CMR 113.50(4). (c)Jurisdiction of incorporation: _______________________________________________________________________ Date of incorporation: _______________________Duration if not perpetual: ________________________________ (month, day, year) P.C. c156ds1532950c11356 01/13/05<<<<<<<<<********>>>>>>>>>>>>> 2 (d) Street address of principal o * ____________________________________________________________________ce: (number, street, city or town, state, zip code) (e) Street address of registered o * ce in the commonw __________________________________________________ealth: (number, street, city or town, state, zip code) Name of registered agent in the commonwealth at the above addr ________________________________________ess: I, _______________________________________________________________________________________________ registered agent of the above corporation consent to my appointment as registered agent pursuant to G. L. Chapter 156D, Section 5.02.* (f) Fiscal year end: __________________________________________________________________________________ (month, day) (g) Brief description of the corporations activities to be conducted in the commonwealth: ________________________________________________________________________________________________ (h) Names and business addresses of its current o * cers and directors: NAME BUSINESS ADDRESS President: Vice-president: Treasurer: Secretary: Assistant secretary: Director(s): Attach certi? cate of legal existence or a certi? cate of good standing issued by an o * cer or agency properly authorized in the jurisdiction of organization. If the certi? cate is in a foreign language, a translation thereof under oath of the translator shall be attached. * Or attach registered agents consent hereto. <<<<<<<<<********>>>>>>>>>>>>> 3(6) Attach a certi? cate from the Commonwealth of Massachusetts Department of Revenue reciting that all corporate excise taxes and any related penalties have been paid or a request to the Department of Revenue for this certi? cate.(7) h e Division shall: (check appropriate box) reinstate the corporation without limitation.* limit reinstatement to a speci? ed period of time not to exceed one year.Signed by: ___________________________________________________________________________________________, (signature of authorized individual) Chairman of the board of directors, President, Other o * cer, Court-appointed ? duciary, on this _________________________day ofday ofday of__________________________________________________________________________________, _____________________.* e corporation must ? le annual reports for the previous ten (10) ? scal years, if not previously ? led.<<<<<<<<<********>>>>>>>>>>>>> 4 COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Application for Reinstatement of Authority to Transact Business (General Laws Chapter 156D, Section 15.32; 950 CMR 113.56) I hereby certify that upon examination of this application for reinstatement, duly submitted to me, it appears that the provisions of the General Laws relative thereto have been complied with, and I hereby approve said application; and the ? ling fee in the amount of $ _________________________________________________ having been paid, said application is deemed to have been ? led with me this _____________day ofday ofday 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: $100 Examiner TO BE FILLED IN BY CORPORATION Contact Information: Name Approval ___________________________________________________________ C ___________________________________________________________ M ___________________________________________________________ #A.R. 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.