D F The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth PC One Ashburton Place, Boston, Massachusetts 02108-1512 FORM MUST BE TYPED Statement of Change of FORM MUST BE TYPED Registered Agent/Registered O ce (General Laws Chapter 156D, Section 5.02 and Section 15.08; 950 CMR 113.21) Exact name of corporation(s): _____________________________________________________________________________ Current registered o * ce address: __________________________________________________________________________ (number, street, city or town, state, zip code) New registered o * ce address: _____________________________________________________________________________ (number, street, city or town, state, zip code) Current registered agent: ________________________________________________________________________________ (name of current registered agent) Registered agent will: (((check apprcheck appropriate boopriate box)x) change to ____________________________________________________________________________________. (name of new registered agent) remain the same. h e street address of the registered o * ce of the corporation and the business address of the registered agent are identical, as re- quired by G. L. Chapter 156D, Section 5.02. h is certi? cate is e ) ective at the time and on the date approved by the Division, unless a later e ) ective date not more than 90 days from the date of ? ling is speci? ed: _________________________________________________________________________ Signed by: ___________________________________________________________________________________________, (signature of authorized individual) Chairman of the board of directors, President, Other o * cer, Court-appointed ? duciary, on this ___________________________________day ofday ofday 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 agents consent hereto. American LegalNet, Inc.P.C. www.USCourtForms.comc156ds502s1508950c11321 01/13/05>>>> 2 COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Statement of Change of Registered Agent/Registered O ce (General Laws Chapter 156D, Section 5.02 and Section 15.08; 950 CMR 113.21) I hereby certify that upon examination of this certi? cate of change, duly submitted to me, it appears that the provisions of the General Laws to the organization of corporations have been complied with, and I hereby approve said statement; and the ? ling fee in the amount of $______ having been paid, said statement is deemed to have been ? led with me this ________day of _________20 at _____a.m./p.m. time E ) ective date: _________________________________________________ (must be within 90 days of date submitted) WILLIAM FRANCIS GALVIN Secretary of the Commonwealth Filing fee: $25 for paper or fax ? lings. No fee if ? led electronically. TO BE FILLED IN BY CORPORATION Contact Information: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Telephone: ___________________________________________________ Email: ______________________________________________________ Upon ? ling, a copy of this ? 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. American LegalNet, Inc. www.USCourtForms.com