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Statement Of Resignation Of Registered Agent Form - The Commonwealth Of Massachusetts Page 2

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)

I hereby certify that upon examination of this statement of resignation, duly

submitted to me, it appears that the provisions of the General Laws relative

to the organization of corporations have been complied with, and I hereby

approve said statement; and the filing fee in the amount of $_____hav-

ing been paid, said statement is deemed to have been filed with me this

_____________ day of _____________, 20______ , at _______a.m./p.m.

time

Effective date: _________________________________________________

(must be within 90 days of date submitted)

WILLIAM FRANCIS GALVIN

Secretary of the Commonwealth

Filing fee: $25 for paper or fax filings.

TO BE FILLED IN BY CORPORATION

Contact Information:

___________________________________________________________

Telephone: ___________________________________________________

Email: ______________________________________________________

Upon filing, a copy of this filing will be available at

If the document is rejected, a copy of the rejection sheet and rejected document will

be available in the rejected queue.

Statement Of Resignation Of Registered Agent Form - The Commonwealth Of Massachusetts Page 2