Certificate Of Resignation Of Resident Agent Form - The Commonwealth Of Massachusetts
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1
2IDENTIFICATION
____________________
no.
Filing Fee: $10.00
The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512
CERTIFICATE OF RESIGNATION OF RESIDENT AGENT
(General Laws, Chapter 180, Section 10C)
I, ____________________________________________________________________________________________ , Resident Agent,
(Exact name of resident agent)
located at ___________________________________________________________________________________________________ ,
(Business address of resident agent)
certify as follows:
1. That I have resigned as resident agent of __________________________________________________________________________
(Exact name of corporation)
having a principal office at ______________________________________________________________________________________ .
(Street address of corporation in Massachusetts)
2. *The effective date of such resignation will be _________________________________ , 20 ________ .
3. I have mailed a copy of this certificate, postage prepaid, to said corporation at its principal office in Massachusetts as currently noted in
the records of the Secretary of the Commonwealth, or because that office is also my office, to the address furnished to me by the corpora-
tion as the place where copies of all processes served upon me are to be forwarded.
SIGNED UNDER THE PENALTIES OF PERJURY, this __________ day of________________________________ , 20 ___________,
______________________________________________________________________________________________ , Resident Agent.
*The effective date of resignation must not be earlier than 30 days after the filing of this certificate.
180crra 11/7/13
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