Statement Of Appointment Of Registered Agent

D The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth PC One Ashburton Place, Boston, Massachusetts 02108-1512 FORM MUST BE TYPED FORM MUST BE TYPED Statement of Appointment of Registered Agent (General Law, Chapter 156D, Section 5.01; 950 CMR 113.20) Exact name of corporation: ______________________________________________________________________________________ Registered o * ce address: ________________________________________________________________________________________ (number, street, city or town, state, zip code) Appoints as registered agent: _____________________________________________________________________________________ (name of registered agent) h e street address of the registered o * ce of the corporation and the business address of the registered agent are identical as required by G.L., Chapter 156D, Section 5.02. 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 authorized individual) Chairman of the board of directors, President, Other o * cer, Court-appointed ? duciary, on this ________________day of ____________________________________, __________. Consent of registered agent: I, _______________________________________________________________________________________, registered agent of the above corporation, consent to my appointment as registered agent pursuant to G.L. Chapter 156D, Section 5.02.* *or attach registered agents consent hereto. American LegalNet, Inc.P.C. www.USCourtForms.comc156ds501950c11320 01/13/05<<<<<<<<<********>>>>>>>>>>>>> 2 COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Statement of Appointment of Registered Agent (General Law, Chapter 156D, Section 5.01; 950 CMR 113.20) I hereby certify that upon examination of this statement of appointment, duly submitted to me, it appears that the provisions of the General Laws relative to the organization of corporations have been complied with, and I hereby approve said statement; and the ?ling fee in the amount of $_____hav- ing been paid, said statement is deemed to have been filed 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