D PC The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 FORM MUST BE TYPED Articles of Charter Surrender Upon Conversion to a Foreign Other Entity FORM MUST BE TYPED (General Laws Chapter 156D, Section 9.54; 950 CMR 113.32) (1) Exact name of corporation: ___________________________________________________________________________ (2) Registered office address: _____________________________________________________________________________ (number, street, city or town, state, zip code) (3) The articles of charter surrender are filed in connection with a conversion to a foreign other entity. (4) The conversion is permitted by the laws of the foreign jurisdiction. (5) Type of entity: _____________________________________________________________________________________ (6) Name of new entity: ________________________________________________________________________________ New jurisdiction of incorporation: ______________________________________________________________________ (7) The corporation hereby appoints the Secretary of the Commonwealth as its agent for service of process in any proceeding to enforce the rights of shareholders who exercise appraisal rights in connection with the conversion. (8) The conversion was duly approved by the shareholders, and where required, by each separate voting group as provided by G.L. Chapter 156D and the articles of organization. (9) Street address of its executive office immediately after the conversion if the surviving entity will be a non-filing entity: ________________________________________________________________________________________________ (number, street, city or town, state, zip code) (10) _ The charter surrender shall be effective at the time and on the date approved by the Division, unless a later effective date not more than 90 days from the date and time of filing is specified: _______________________________________________ Signed by: ___________________________________________________________________________________________ , (signature of authorized individual) ® Chairman of the board of directors, ® President, ® Other officer, ® Court-appointed fiduciary, on this _________________________ day of_________________________________________ , _____________________ . of American LegalNet, Inc. www.USCourtForms.com P.C. c156ds954950c11332 07/19/05 COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Articles of Charter Surrender Upon Conversion to a Foreign Other Entity (General Laws Chapter 156D, Section 9.54; 950 CMR 113.32) I hereby certify that upon examination of this certificate of charter surrender,it appears that the provisions of the General Laws relative thereto have been complied with, and the filing fee in the amount of $______ having been paid, said certificate 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 #A.R. Filing fee: Minimum $250 TO BE FILLED IN BY CORPORATION Contact Information: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Telephone: ___________________________________________________ Email: ______________________________________________________ Upon filing, a copy of this filing 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. American LegalNet, Inc. www.USCourtForms.com