Massachusetts Professional Corporation Annual Report - Commonwealth Of Massachusetts
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1The Commonwealth of Massachusetts
PC
FEE: 125.00
William Francis Galvin
MASSACHUSETTS
PROFESSIONAL
Secretary of the Commonwealth
CORPORATION
One Ashburton Place, Boston, Massachusetts 02108-1512
ANNUAL REPORT
Telephone: (617) 727-9640
FEDERAL IDENTIFICATION
NOTE: PLEASE TYPE OR PRINT CLEARLY!
NO. _____________________
INSTRUCTIONS ON OTHER SIDE
1. The EXACT name of the corporation is: ______________________________________________________________________
2. Location of its principal office in Massachusetts is: _____________________________________________________________
__________________________________________________________________________________________________________
NOTE: If the corporation is organized wholly to do business outside of Massachusetts, give the location of that office as well.
__________________________________________________________________________________________________________
3. Name and address of the Resident Agent, if any: _______________________________________________________________
__________________________________________________________________________________________________________
4. Date of the end of the last fiscal year was: ____________________________________________________________________
(month)
(day)
(year)
5. The capital stock of each class as of the end of its last fiscal year was:
Par Value per Share
Total Authorized
Total Issued and Outstanding
CLASS OF STOCK
State if no Par
Number of Shares
Total Par Value
Number of Shares
COMMON:
PREFERRED:
6. State the names and residential 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
RESIDENTIAL ADDRESS
EXPIRATION
OF TERM
Number and Street, City or Town, State, Zip Code
PRESIDENT
TREASURER
CLERK
DIRECTORS
7. The names and residential addresses of all shareholders, whether individuals, partners, or professional corporations are:
NAME
RESIDENTIAL ADDRESS
Number and Street, City or Town, State, Zip Code
I, the undersigned ___________________________ being the ______________________ of the above-named corporation, do
hereby certify, pursuant to Section 18 of Chapter 156A of the Massachusetts General Laws, that the above-listed shareholders, and
all the partners of a general partnership which is a shareholder of the corporation are duly licensed to render one or more
professional services for which the corporation was organized, or are professional corporations authorized to render such
professional services, and that a copy of this report is being sent to the appropriate regulating board. I further certify that, in
compliance with the General Laws, Chapter 156A and 156B, all the 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 __________________________________ , 20 ________ .
Signature: ____________________________________________ Title: ________________________________________________
Contact Person: _______________________________________ Contact Person Telephone #: ___________________________
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