Free MBCA-12B - Maine

Filing Fee $90.00

FOREIGN BUSINESS CORPORATION STATE OF MAINE

APPLICATION OF WITHDRAWAL

_____________________ Deputy Secretary of State A True Copy When Attested By Signature

______________________________________
(Name of Corporation)

_____________________ Deputy Secretary of State

Pursuant to 13-C MRSA §1521 or §1523, the undersigned foreign corporation executes and delivers the following Application of Withdrawal: FIRST: SECOND: THIRD: FOURTH: The jurisdiction of its incorporation is _______________________________________________________________. The date on which it was authorized to do business in the State of Maine is ________________________________. The foreign corporation is not transacting business in this State and that it surrenders its authority to transact business in this State. (For Foreign Corporation Upon Conversion to a Nonfiling Entity): The type of other entity to which the foreign business corporation has been converted is _______________________ _____________ and the jurisdiction whose laws govern its internal affairs is ________________________________. FIFTH: The foreign corporation revokes the authority of its registered agent to accept service on its behalf and appoints the Secretary of State as its agent for service of process in any proceeding based on a cause of action arising during the time it was authorized to transact business in this State. The mailing address to which the Secretary of State may mail a copy of any process served on the Secretary of State: ______________________________________________________________________________________________.
(street, city, state and zip code)

SIXTH:

The foreign corporation is committed to notify the Secretary of State in the future of any change in its mailing address. *By __________________________________________________
(signature of any duly authorized officer)

DATED _________________________

__________________________________________________
(type or print name and capacity)

*This document MUST be signed by any duly authorized officer. (13-C MRSA §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-12B (1 of 1) Rev. 8/1/2004 TEL. (207) 624-7752