Massachusetts Corporation Regulatory Board Certificate Form
In the case of activities that required approval from specific regulatory bodies in the Commonwealth, the Massachusetts Corporation Regulatory Board Certificate Form has to be completed and submitted.
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FORM MUST BE TYPEDFORM MUST BE TYPED The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Certifi cate by Regulatory Board** (General Laws, Chapter 112 or 221) In compliance with General Laws, Chapter 156A, Section 7, the __________________________________________________________ (Exact name of board) hereby certifi es that in connection with the incorporation of ____________________________________________________________ hereby certifi es that in connection with the incorporation of ____________________________________________________________ hereby certifi es that in connection with the incorporation of , (Exact name of corporation) a professional corporation formed to render ___________________________________________________________________ services, (Type of professional service to be rendered) the below listed incorporators, offi cers, directors, and shareholders are duly licensed or admitted to practice the profession listed above. INCORPORATORS RESIDENTIAL ADDRESS OFFICERS RESIDENTIAL ADDRESS DIRECTORS RESIDENTIAL ADDRESS SHAREHOLDERS RESIDENTIAL ADDRESS SIGNED this _______________________________ day of _____________________________________________ day of _____________________________________________ day of , 20 __________ , by _________________________________________________________________________________________by _________________________________________________________________________________________by , *Chairman / *Clerk. *Delete the inapplicable word.**Certain regulatory boards may require a fee for the issuance of this certifi cate. 112crgbd 7/29/04
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