Form Df - Annual Report For Domestic And Foreign Corporations

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D F

Filing Fee: $125.00

Late Fee: $25.00

The Commonwealth of Massachusetts

William Francis Galvin

Secretary of the Commonwealth

One Ashburton Place - Room 1717, Boston, Massachusetts 02108-1512

Annual Report for Domestic

FORM MUST BE TYPED

and Foreign Corporations

(General Laws Chapter 156D, Section 16.22; 950 CMR 113.57)

(1) Exact name of the corporation:

(2) Jurisdiction of incorporation:

(3) Street address of the corporation’s registered office in the commonwealth (number, street, city or town, state, zip code):

(4) Name of the registered agent at the registered office:

(5) Street address of the corporation’s principal office (number, street, city or town, state, zip code):

(6) Provide the names and addresses of the corporation’s board of directors and its president, treasurer, secretary, and if different, its chief executive

officer and chief financial officer.

NAME

ADDRESS

President:

Treasurer:

Secretary:

Chief Executive Officer:

Chief Financial Officer:

Directors:

(7) Briefly describe the business of the corporation:

(8-9) Capital stock of each class and series:

CLASS OF STOCK