D 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 Supplemental FORM MUST BE TYPED Information Contained in Article VIII of Articles of Organization (General Laws Chapter 156D, Section 2.02 and Section 8.45; 950 CMR 113.17) (1) Exact name of the corporation: ________________________________________________________________________ (2) Current registered o ce address: _______________________________________________________________________ (number, street, city or town, state, zip code) (3) h e following supplemental information has changed: (check appropriate box) Names and addresses of the directors, president, treasurer and secretary (an address need not be speci? ed if the business address of the o cer or director is the same as the principal o ce location): President: Treasurer: Secretary: Director(s): Fiscal year end: ________________________________________________________________________________ (month, day) Principal o ce address: __________________________________________________________________________ (number, street. city or town, state, zip code) Type of business in which the corporation intends to engage: ____________________________________________________________________________________________ Other: ____________________________________________________________________________________________ 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: _________________________________________________________________________ American LegalNet, Inc.P.C. www.USCourtForms.com c156ds202s845950c11317 01/13/05>>>> 2Signed by: ___________________________________________________________________________________________, (signature of authorized individual) Chairman of the board of directors, President, Other o cer, Court-appointed ? duciary, on this ___________________________________day ofday ofday of ____________________________________________________________, ______________________. American LegalNet, Inc. www.USCourtForms.com>>>> 3 COMMONWEALTH OF MASSACHUSETTS William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512 Statement of Change of Supplemental Information Contained in Article VIII of Articles of Organization (General Laws Chapter 156D, Section 2.02 and Section 8.45; 950 CMR 113.17) I hereby certify that upon examination of this statement of change, duly submit- ted to me, it appears that the provisions of the General Laws relative thereto have been complied with, and I hereby approve said statement; and the ? ling fee in the amount of $ ______________________________________________________ having been paid, said articles are 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) Examiner WILLIAM FRANCIS GALVIN Secretary of the Commonwealth Filing fee; $25 for paper or fax ? ling. 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