Statement Of Resignation Of Registered Agent Form - The Commonwealth Of Massachusetts


The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Statement of Resignation
of Registered Agent
(General Laws Chapter 156D, Section 5.03 and Section 15.09; 950 CMR 113.23)
Name of registered agent:
Exact name of corporation:
Current registered office address:
(number, street, city or town, state, zip code)
The above named registered agent hereby resigns his appointment as registered agent of the corporation.
The registered office address will:
Check appropriate box)
also be discontinued.
remain the same.
It is hereby certified that a copy of this statement of resignation shall be furnished to the corporation pursuant to G. L. Chapter
156D, Section 5.03 and Section 15.09.
The appointment is terminated, and the registered office discontinued, if so provided, on the thirty-first day after the
date on which the statement is filed, unless a later effective date not more than 90 days from the date and time of filing is
Signed by:
___________________________________________________________________________________________ ,
(signature of registered agent)
on this
___________________________________ day of ______________________________of ____________________ .
c156ds503s1509950c11323 6/23/10


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