Section 109. Every corporation shall annually, on or before the fifteenth day of the third month following the close of its fiscal year, prepare and submit to the state secretary a report which shall be signed under the penalties of perjury by an officer of the corporation stating:—
(1) The name of the corporation.
(2) The location (with street address) of its principal office in the commonwealth, and elsewhere in the case of a corporation organized to do business wholly outside the commonwealth.
(3) The total amount of its authorized capital stock so far as it consists of shares with par value, and the total number of its shares without par value authorized to be issued; the amount of stock with par value, and the number of shares without par value, issued and outstanding; the class or classes and series, if any, into which it is divided; the par value, if any, and the number of its shares.
(4) The names and addresses of the president, treasurer, clerk and all the directors of the corporation, and the date at which the term of office of each expires and the name and address of the resident agent, if any.