Application Form For Revival - $100 Fee

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FEDERAL IDENTIFICATION
NO. _____________________
Fee: $100.00
The Commonwealth of Massachusetts
Examiner
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
APPLICATION FOR REVIVAL
(General Laws, Chapter 156B, Section 108)
1. Exact name of corporation is: _____________________________________________________________
2. Name of applicant is: ___________________________________________________________________
3. Address of applicant is: __________________________________________________________________
4. State fully the applicant’s relationship to, or interest in, the corporation:
5. The date of dissolution of the corporation is: _______________________________________________________
6. The corporation was dissolved under the provisions of General Laws, Chapter 156B, Section _____________________
7. Describe fully the circumstances leading to the dissolution of this corporation:
P.C.
156barev 2/26/16

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