Free Application for revival - Massachusetts

MSC.1

FEDERAL IDENTIFICATION NO. _____________________

Fee: $40.00

The Commonwealth of Massachusetts
Examiner

William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512

APPLICATION FOR REVIVAL
(General Laws, Chapter 180, Section 10C)

1. Exact name of corporation is: 2. Name of applicant is: 3. Address of applicant is: 4. State fully the applicant's relationship to, or interest in, the corporation:

5. Date of dissolution or revocation of charter of the corporation is:

6. The corporation was dissolved or the charter was revoked under the provisions of General Laws, Chapter 180, Section __________ . 7. Describe fully the circumstances leading to the dissolution or revocation:

P.C.
180arev 4/5/00

8. Describe fully the activities, if any, of the corporation since dissolution or revocation of the charter:

9. Does the applicant seek a limited or general revival? If limited, state fully the reason(s) therefore, and period of time (not exceeding one year) sought for the revival:

SIGNED UNDER THE PENALTIES OF PERJURY, this ___________ day of _______________________________ , 20 _________ ,

______________________________________________________________________________________ , Signature of Applicant.

I hereby approve the within Application for Revival 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 _____ .

WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth