F
The Commonwealth of Massachusetts
FPC
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512
Foreign Application For
FORM MUST BE TYPED
FORM MUST BE TYPED
Transfer of Authority
(General Laws, Chapter 156D, Section 15.23; 950 CMR 113.53)
(1) Exact name of corporation: ___________________________________________________________________________
(2) Type of other entity into which the corporation has converted: ________________________________________________
(3) Jurisdiction upon transfer of authority: __________________________________________________________________
(4) Attach an additional sheet(s) containing all other information required in a fi ling under the laws of the commonwealth by an
other entity of the type the corporation has become seeking authority to transact business in the commonwealth.
(5) Th is application is eff ective at the time and on the date approved by the Division, unless a later eff ective date is specifi ed in
accordance with the organic law of the surviving entity: _____________________________________________________
Attach certifi cate of legal existence or a certifi cate of good standing issued by an offi cer or agency properly authorized in the
jurisdiction of organization. If the certifi cate is in a foreign language, a translation thereof under oath of the translator shall be
attached.
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.
c156ds1523950c11353 07/19/05
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