Report Of Voluntary Associations And Trusts - The Commonwealth Of Massachusetts
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1
2f
iled for the year 20
____
Fee: $75.00
The Commonwealth of Massachusetts
William rancis Galvin
f
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
report of voluntary associations and trusts
(General aws, hapter 182, ection 12)
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c
s
1. Exact name of trust:
2. Street address of principal office in Massachusetts:
3. Street address elsewhere, if doing business outside Massachusetts:
4. Number of issued and outstanding transferable certificates of participation or shares:
5. The names and addresses of all the trustees are as follows:
n
ame
a
ddress
*I/We the trustee(s) of the above named trust,
__________________________________________________________________
, declare under penalties of perjury that I/we have examined this report and that to the best of my/our information and belief,
the statements contained herein are true and correct and hereto sign my/our name(s) this
_______ day of ______________________________, 20 _______ .
**
___________________________________________ , Trustee
____________________________________________ , Trustee
*Delecte the inapplicable wards.
**The trustee, or if more than one trustee, then at least two trustees, shall sign under the penalties of perjury.
I have examined this Report of Voluntary Associations and Trusts and
found it to conform with the requirements of Massachusetts Gen-
eral Laws, Chapter 182, Section 12 and the filing fee in the amount of
$ __________ , having been paid, said report is deemed to have been
filed with me this________ day of____________________ , 20 ______ .
William rancis Galvin
f
Secretary of the Commonwealth
182rptva 6/13/01
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