Registrant Name Or Affress Amendment - Commonwealth Of Massachusetts Page 2
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4(3) For each class provide the number and class in which such goods or services fall (see attached classification schedule):
(4) Provide the Massachusetts registration date and number:
(5) Registrant’s name has been changed to:
a) Individual: ______________________________________________________________________________________
Last
First
Middle
or
b) Business Organization: _____________________________________________________________________________
(6) Registrant’s business address has been changed to:
_______________________________________________________________________________________________
Number
Street
_______________________________________________________________________________________________
City
State
Zip
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