Filing Fee $20.00
BUSINESS CORPORATION STATE OF MAINE
TERMINATION OF STATEMENT OF INTENTION TO DO BUSINESS UNDER AN ASSUMED OR FICTITIOUS NAME
_____________________ Deputy Secretary of State
A True Copy When Attested By Signature
______________________________________
(Real Name of Corporation)
_____________________ Deputy Secretary of State
Pursuant to 13-C MRSA §404.8, the undersigned corporation executes and delivers the following Termination of Statement of Intention to do Business Under an Assumed or Fictitious Name: FIRST: SECOND: The corporation no longer intends to transact business under an assumed or fictitious name. The corporation intends to terminate the assumed or fictitious name of ______________________________________________________________________________________________.
DATED _________________________
*By __________________________________________________
(signature of any duly authorized person)
__________________________________________________
(type or print name and capacity)
*This document MUST be signed by any duly authorized officer OR the clerk. (§121.5) Please remit your payment made payable to the Maine Secretary of State. SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MBCA-5A 7/1/2003 TEL. (207) 624-7752