Articles Of Charter Surrender Upon Foreign Non-Profit Conversion - The Commonwealth Of Massachusetts

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D
The Commonwealth of Massachusetts
PC
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Articles of Charter Surrender
FORM MUST BE TYPED
FORM MUST BE TYPED
Upon Foreign Non-profi t Conversion
(General Laws Chapter 156D, Section 9.33; 950 CMR 113.27)
(1) Exact name of corporation: ___________________________________________________________________________
(2) Registered offi ce address: _____________________________________________________________________________
(number, street, city or town, state, zip code)
(3) Th e articles of charter surrender are fi led in connection with the conversion of the corporation to a foreign non-profi t corpora-
tion.
(4) Th e conversion is permitted by the laws of the foreign jurisdiction.
(5) Corporation’s new name: _____________________________________________________________________________
New jurisdiction of incorporation: _____________________________________________________________________
(6) Th e foreign non-profi t conversion was duly approved by the shareholders, and where required, by each separate voting group
as provided by G.L. Chapter 156D and the articles of organization.
(7) Th e corporation hereby appoints the Secretary of the Commonwealth as its agent for service of process in any proceeding to
enforce the rights of shareholders who exercise appraisal rights in connection with the conversion.
(8) Th e charter surrender shall be eff ective at the time and on the date approved by the Division, unless a later eff ective date not
more than 90 days from the date and time of fi ling is specifi ed: ________________________________________________
Signed by: ___________________________________________________________________________________________ ,
(signature of authorized individual)
® Chairman of the board of directors,
® President,
® Other offi cer,
® Court-appointed fi duciary,
on this _________________________ day of_________________________________________
day of_________________________________________
day of
, _____________________ .
P.C.
c156ds933950c11327 01/13/05

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