Massachusetts Foreign Corporation Annual Report Form

In Massachusetts, all foreign corporations are required to update their business information through the submission of an annual report. Prior submission, a check for the $125.00 filing fee must be attached to the report form. For late submissions, the filing fee is $150.00.Download

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FORM MUST BE TYPED	
The Commonwealth of Massachusetts	
William Francis Galvin
Secretary of the Commonwealth
One Ash\furton Place - \boom 1717, Boston, M\sassachusetts 02108-151\s2	
c156as18c156ds1622  10/26/09	
PC
FPC	
Filing Fee: $12\f.00
La\be Fee: $2\f.00	
Annual Repor\b for Professional and  Foreign Professional Corpora\2\bions	
(General Laws Chap\ber\2 1\f6A, Sec\bion 18 and Chap\be\2r 1\f6D, Sec\bion 16.22)	
(1)	 E	xact name of the c\sorporation:	 __________________\s__________________\s__________________\s__________________\s_______________	
(2)	 J	urisdiction of inco\srporation:	 __________________\s__________________\s__________________\s__________________\s_________________	
(3)	 S	treet address of the corporat\sion’s registered office in the com\smonwealth:	 	
 __________________\s__________________\s__________________\s__________________\s__________________\s__________________\s___	
	 (number, 	 street, 	 city 	 or 	 town, 	 state, 	 zip 	 co\fe)
(4)	 N	ame of the registered agent at the registered office:	 __________________\s__________________\s__________________\s_________________	
(5)	 S	treet address of the corporat\sion’s principal office:	 	
 __________________\s__________________\s__________________\s__________________\s__________________\s__________________\s___	
	(number, 	 street, 	 city 	 or 	 town, 	 state, 	 zip 	 co\fe)
(6)	 P	rovide the names and \saddresses of the corpora\stion’s \foard of directors, shareholders, and its p\sresident, treasurer, secretary, and 	if different, its 
chief executive officer and chief \sfinancial officer.	
   	NAME	  	ADD\bESS	
 	P	resident:	 __________________\s__________________\s__________________\s__________________\s__________________\s______________	
 	T	reasurer:	 __________________\s__________________\s__________________\s__________________\s__________________\s______________	
 	S	ecretary:	 __________________\s__________________\s__________________\s__________________\s__________________\s______________	
 	Chief E	xecutive Officer:	 __________________\s__________________\s__________________\s__________________\s__________________\s___	
 	Chief F	inancial Officer:	 __________________\s__________________\s__________________\s__________________\s__________________\s___	
 	D	irectors: 	 __________________\s__________________\s__________________\s__________________\s__________________\s_____________	
 __________________\s__________________\s__________________\s__________________\s__________________\s__________________\s___	
 	S	hareholders (with residential address): 	 __________________\s__________________\s__________________\s__________________\s_________	
(7)	 B	riefly descri\fe the \s\fusiness of the corp\soration:
 	 __________________\s__________________\s__________________\s__________________\s__________________\s__________________\s___	
(8-9)	 Capital stock of ea\sch class and series:\s
CLASS OF STOCKTOTAL AUTHO\bIZED BY A\bTICLES OF  
O\bGANIZATION O\b AMENDMENTS Num\fer of Shares TOTAL ISSUED AND OUTSTANDING
Num\fer of Shares
COMMON
P\bEFE\b\bED	
(10)	 Check if the stock \sof the corporation\s is pu\flicly traded\s. 	
(11)	 \b	eport is filed for fiscal\s year ending: 	 __________________\s______	/ __________________\s______	/__________________\s_____________
	 (month)	(\fay)	(y	
 ear)
It is here\fy certified, pursuant to \sG.L. Chapter 156A,\s Section 18, that the\s shareholders, and all t\she partners of a general \spartnership which is a\s share -
holder of the corp\soration are duly licensed to \srender one or more professional services for which the\s corporation was or\sganized, or are professional 
corporations author\sized to render such professional services, and that a c\sopy of this report is \feing sent to t\she appropriate regulatory \foard.
 
Signed \fy:	
 __________________\s__________________\s__________________\s__________________\s__________________\s________________	
	Chairman of the \foa\srd of directors	 	 President  	 Other officer  	 Court appointed fiducia\sry	
on this	 __________________\s__________________\s	day of	 __________________\s__________________\s___________	,  _________________	.