Looking for a Massachusetts Legal Forms And Templates? Download it for free!

Foreign Certificate Of Withdrawal Upon Conversion To A Nonfiling Entity - The Commonwealth Of Massachusetts Page 2

COMMONWEALTH OF MASSACHUSETTS

William Francis Galvin

Secretary of the Commonwealth

One Ashburton Place, Boston, Massachusetts 02108-1512

Foreign Certiﬁ cate of Withdrawal

Upon Conversion to a Nonﬁ ling Entity

(General Laws Chapter 156D, Section 15.22; 950 CMR 113.52)

I hereby certify that upon examination of this foreign certiﬁ cate withdrawal, duly

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

have been complied with, and I hereby approve said certiﬁ cate; and the ﬁ ling fee in

the amount of $ ___________________________________________________

having been paid, said certiﬁ cate is deemed to have been ﬁ led with me this

_____________ day of _____________

day of _____________

day of

, 20______ , at _______a.m./p.m.

time

Eﬀ ective date: _____________________________________________________

(must be within 90 days of date submitted)

WILLIAM FRANCIS GALVIN

Secretary of the Commonwealth

Filing fee: $100

Examiner

TO BE FILLED IN BY CORPORATION

# A.R.

Contact Information:

___________________________________________________________

Telephone: ___________________________________________________

Email: ______________________________________________________

Upon ﬁ ling, a copy of this ﬁ ling 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.

Foreign Certificate Of Withdrawal Upon Conversion To A Nonfiling Entity - The Commonwealth Of Massachusetts Page 2