"Statement of Appointment of Registered Agent" - Massachusetts

Statement of Appointment of Registered Agent is a legal document that was released by the Secretary of the Commonwealth of Massachusetts - a government authority operating within Massachusetts.

Form Details:

  • Released on January 13, 2005;
  • The latest edition currently provided by the Secretary of the Commonwealth of Massachusetts;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Secretary of the Commonwealth of Massachusetts.

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Download "Statement of Appointment of Registered Agent" - 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
Statement of Appointment
of Registered Agent
(General Law, Chapter 156D, Section 5.01; 950 CMR 113.20)
Exact name of corporation: ______________________________________________________________________________________
Registered offi ce address: ________________________________________________________________________________________
(number, street, city or town, state, zip code)
Appoints as registered agent: _____________________________________________________________________________________
(name of registered agent)
Th e street address of the registered offi ce of the corporation and the business address of the registered agent are identical as required by G.L.,
Chapter 156D, Section 5.02.
Th is certifi cate is eff ective at the time and on the date approved by the Division, unless a later eff ective date not more than 90 days from the
date of fi ling is specifi ed: ________________________________________________________________________________________
Signed by: __________________________________________________________________________________________________ ,
(signature of authorized individual)
® Chairman of the board of directors,
® President,
® Other offi cer,
® Court-appointed fi duciary,
on this ________________day of ____________________________________ , __________ .
Consent of registered agent:
I, _______________________________________________________________________________________ ,
registered agent of the above corporation, consent to my appointment as registered agent pursuant to G.L. Chapter
156D, Section 5.02.*
*or attach registered agent's consent hereto.
P.C.
c156ds501950c11320 01/13/05
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
Statement of Appointment
of Registered Agent
(General Law, Chapter 156D, Section 5.01; 950 CMR 113.20)
Exact name of corporation: ______________________________________________________________________________________
Registered offi ce address: ________________________________________________________________________________________
(number, street, city or town, state, zip code)
Appoints as registered agent: _____________________________________________________________________________________
(name of registered agent)
Th e street address of the registered offi ce of the corporation and the business address of the registered agent are identical as required by G.L.,
Chapter 156D, Section 5.02.
Th is certifi cate is eff ective at the time and on the date approved by the Division, unless a later eff ective date not more than 90 days from the
date of fi ling is specifi ed: ________________________________________________________________________________________
Signed by: __________________________________________________________________________________________________ ,
(signature of authorized individual)
® Chairman of the board of directors,
® President,
® Other offi cer,
® Court-appointed fi duciary,
on this ________________day of ____________________________________ , __________ .
Consent of registered agent:
I, _______________________________________________________________________________________ ,
registered agent of the above corporation, consent to my appointment as registered agent pursuant to G.L. Chapter
156D, Section 5.02.*
*or attach registered agent's consent hereto.
P.C.
c156ds501950c11320 01/13/05
COMMONWEALTH OF MASSACHUSETTS
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Statement of Appointment
of Registered Agent
(General Law, Chapter 156D, Section 5.01; 950 CMR 113.20)
I hereby certify that upon examination of this statement of appointment,
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 fi ling 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
Eff ective date: _________________________________________________
(must be within 90 days of date submitted)
WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth
Filing fee: $25 for paper or fax fi lings.
No fee if fi led electronically.
TO BE FILLED IN BY CORPORATION
Contact Information:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Telephone: ___________________________________________________
Email: ______________________________________________________
Upon fi ling, a copy of this fi ling will be available at www.sec.state.ma.us/cor.
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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