Professional Limited Liability Company Annual Report Form - The Commonwealth Of Massachusetts Page 3

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COMMONWEALTH OF MASSACHUSETTS
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Professional Limited Liability Company Annual Report
(General Laws Chapter 156C, Section 12)
I hereby certify that upon examination of this professional limited liability company
annual report, duly submitted to me, it appears that the provisions of the General
Laws relative thereto have been complied with, and I hereby approve said applica
-
tion; and the filing fee in the amount of $ ___ having been paid, said application
is deemed to have been filed with me this
________________ day of ________________ , 20 _____, at _______a.m./p.m.
time
WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth
Filing fee: $500
TO BE FILLED IN BY LIMITED LIABILITY COMPANY
Contact Information:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Telephone:
___________________________________________________
Email:
______________________________________________________
Upon filing, a copy of this filing will be available at
If the document is rejected, a copy of the rejection sheet and rejected document will
be available in the rejected queue.
c156cs12pllcannual 10/14/08

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