Filing Fee $35.00
FOREIGN BUSINESS CORPORATION STATE OF MAINE COMMERCIAL REGISTERED AGENT
STATEMENT OF APPOINTMENT or CHANGE
_____________________ Deputy Secretary of State
A True Copy When Attested By Signature
_____________________________________________ (Name of Corporation)
_____________________ Deputy Secretary of State
Pursuant to 5 MRSA §§105 & 108 the undersigned corporation executes and delivers the following statement of appointment or change of a commercial registered agent. FIRST: The name and address of the current registered agent appearing on the record in the Secretary of State's office: _______________________________________________________________________________ (name of current registered agent) _______________________________________________________________________________ (physical street address, city, state and zip code) SECOND: The new CRA Public number is: __________________________ The name of the new CRA is: _______________________________________________________ THIRD: Pursuant to 5 MRSA §108.3, the registered agent as listed above has consented to serve as the registered agent for this corporation. Jurisdiction of incorporation: ________________________________________________________________ __________________________________________
FOURTH:
Date authorized to transact business in the State of Maine:
Dated _________________________
*By
______________________________________________ (signature) _______________________________________________ (type or print name and capacity)
*This statement MUST be signed by any duly authorized officer. Please remit your payment made payable to the Maine Secretary of State. Submit completed form to: Secretary of State Division of Corporations, UCC and Commissions 101 State House Station, Augusta, ME 04333-0101 Telephone Inquiries: (207) 624-7752 Email Inquiries: [email protected]
Form No. MBCA-12D-CRA 7/1/2008
Filer Contact Cover Letter
To:
Department of the Secretary of State Division of Corporations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101
Tel. (207) 624-7752
Name of Entity (s): _______________________________________________________________________ _______________________________________________________________________ List type of filing(s) enclosed (i.e. Articles of Incorporation, Articles of Merger, Articles of Amendment, Certificate
of Correction, etc.) Attach additional pages as needed.
________________________________________________________________________ ________________________________________________________________________ Special handling request(s): (check all that apply) Hold for pick up Expedited filing - 24 hour service ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 additional filing fee per entity, per service) Total filing fee(s) enclosed: $ ________________ Contact Information questions regarding the above filing(s), please call or email: (failure to provide a contact name and telephone number or email address will result in the return of the erroneous filing (s) by the Secretary of State's office) ___________________________________
(Name of contact person)
___________________________________
(Daytime telephone number)
____________________________________________________
(Email address)
The enclosed filing(s) and fee(s) are submitted for filing. Please return the attested copy to the following address:
______________________________________________________________________________
(Name of attested recipient)
_____________________________________________________________________________________________
(Firm or Company)
_____________________________________________________________________________________________
(Mailing Address)
_____________________________________________________________________________________________
(City, State & Zip)