Certificate By Regulatory Board

The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 FORM MUST BE TYPED Certi? cate by Regulatory Board** FORM MUST BE TYPED (General Laws, Chapter 112 or 221) In compliance with General Laws, Chapter 156A, Section 7, the __________________________________________________________ (Exact name of board) herherherebebeby cery cery certi?ti?ti? es that in connection with the incorporation ofes that in connection with the incorporation ofes that in connection with the incorporation of ________________________________________________________________________________________________________________________, (Exact name of corporation) a professional corporation formed to render ___________________________________________________________________services, (Type of professional service to be rendered) the below listed incorporators, o * cers, directors, and shareholders are duly licensed or admitted to practice the profession listed above. INCORPORATORS RESIDENTIAL ADDRESS OFFICERS RESIDENTIAL ADDRESS DIRECTORS RESIDENTIAL ADDRESS SHAREHOLDERS RESIDENTIAL ADDRESS SIGNED this _______________________________ day ofday ofday of __________________________________________________________________________________________, 20 __________,bbbyyy __________________________________________________________________________________________________________________________________________________________________________________, *Chairman / *Clerk.*Delete the inapplicable word. **Certain regulatory boards may require a fee for the issuance of this certi? cate. 112crgbd 7/29/04