Application For Reinstatement Following Administrative Dissolution - The Commonwealth Of Massachusetts

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D
The Commonwealth of Massachusetts
PC
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
FORM MUST BE TYPED
FORM MUST BE TYPED
Application For Reinstatement
Following Administrative Dissolution
(General Laws Chapter 156D, Section 14.22; 950 CMR 113.47)
(1) Exact name of corporation: ___________________________________________________________________________
(2) Registered office address: _____________________________________________________________________________
(number, street, city or town, state, zip code)
Name of the registered agent at registered office: ___________________________________________________________
(3) Effective date of the corporation’s administrative dissolution: __________________________________________________
(month, day, year)
(4) The grounds for administrative dissolution:
(check appropriate box)
® did not exist.
® have been eliminated.
(5) The corporation’s name satisfies the requirements of G.L. Chapter 156D, Section 4.01 or the corporation shall simultaneously
submit a certificate of amendment to change its name to a name that satisfies the requirements of G.L. Chapter 156D, Section
4.01.
(6) The reinstatement of the corporation shall be effective at the time and on the date approved by the Division, unless a later ef-
fective date not more than 90 days from the date and time of filing is specified: ____________________________________
(7) Attach a certificate from the Commonwealth of Massachusetts Department of Revenue reciting that all corporate excise taxes
and any related penalties have been paid or a request to the Department of Revenue for this certificate.
(8) The Division shall:
(check appropriate box)
® reinstate the corporation without limitation.*
® limit reinstatement to a specified period of time not to exceed one year.
* The corporation must file annual reports for the previous ten (10) fiscal years, if not previously filed.
P.C.
c156ds142295011347 01/13/05

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