Massachusetts Foreign Corporation Annual Report Form - Massachusetts Secretary Of State
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1The Commonwealth of Massachusetts
FEE: $85.00
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Telephone: (617) 727-9640
NOTE: PLEASE TYPE OR PRINT CLEARLY! INSTRUCTIONS ON OTHER SIDE.
MASSACHUSETTS FOREIGN CORPORATION ANNUAL REPORT
Federal Identification No. ____________________________________________
1. The exact name of the corporation is: _______________________________________________________________________
2. The corporation is organized under the laws of: _______________________________________________________________
3. Location of its principal office is: ____________________________________________________________________________
(number and street)
__________________________________________________________________________________________________________
(city or town)
(state)
(zip)
4. The location of its Massachusetts office, if any: ________________________________________________________________
(number and street)
__________________________________________________________________________________________________________
(city or town)
(state)
(zip)
5. Name and address of the Resident Agent is: ___________________________________________________________________
(name)
__________________________________________________________________________________________________________
(number and street)
(city or town)
(state)
(zip)
6. Date of the end of the last fiscal year was: ____________________________________________________________________
(month)
(day)
(year)
7. Check here if the corporation stock is publicly traded:
.
8. The capital stock of each class as of the end of its last fiscal year was:
CLASS OF STOCK
PAR VALUE PER SHARE
TOTAL AUTHORIZED BY ARTICLES
TOTAL ISSUED
STATE IF NO PAR
OF ORGANIZATION OR AMENDMENTS
AND OUTSTANDING
Number of Shares
Total Par Value
Number of Shares
COMMON:
PREFERRED:
9. State the names and addresses of the officers specified below and of all the directors of the corporation, and the date on
which the term of office of each expires:
OFFICERS
NAME
BUSINESS ADDRESS
EXPIRATION
Number, Street, City or Town, State, Zip Code
OF TERM
PRESIDENT
TREASURER
CLERK
DIRECTORS
I, the undersigned _______________________________________, being the ______________________________________ of the
above-named corporation, in compliance with the General Laws, Chapter 181, hereby certify that the above information is true
and correct as of the dates shown. IN WITNESS WHEREOF AND UNDER PENALTIES OF PERJURY, I hereto sign my name on this
_________________________________________________ day of _______________________________________ , 19 _______ .
Signature: ____________________________________________ Title: ________________________________________________
Contact Person: _______________________________________ Contact Person Telephone #: ___________________________
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