Application For Reinstatement Following Administrative Dissolution - The Commonwealth Of Massachusetts Page 3

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COMMONWEALTH OF MASSACHUSETTS
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Application for Reinstatement
Following Administrative Dissolution
(General Laws Chapter 156D, Section 14.22; 950 CMR 113.47)
I hereby certify that upon examination of this application for reinstatement, duly submit-
ted to me, it appears that the provisions of the General Laws relative thereto have been
complied with, and I hereby approve said application; and the filing fee in the amount
of $______ having been paid, said application 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
Examiner
Name approval
Filing fee: $100
#A.R.
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.

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