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

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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

specified:

____________________________________________________________________________________________

Signed by:

___________________________________________________________________________________________ ,

(signature of registered agent)

on this

___________________________________ day of ______________________________of ____________________ .

c156ds503s1509950c11323 6/23/10

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