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FOREIGN BUSINESS CORPORATION STATE OF MAINE

APPLICATION FOR TRANSFER OF AUTHORITY

_____________________ Deputy Secretary of State

A True Copy When Attested By Signature

______________________________________
(Name of Corporation)

_____________________ Deputy Secretary of State

Pursuant to 13-C MRSA §1524, the undersigned foreign corporation executes and delivers the following Application for Transfer of Authority: FIRST: The current jurisdiction of its incorporation is _________________________________________________________ and the date on which it was authorized to transact business in the State of Maine is __________________________. SECOND: The type of entity to which it has been converted: ("X" one box only.) Foreign Nonprofit Corporation Foreign Limited Partnership Foreign Limited Liability Company Foreign Limited Liability Partnership THIRD: FOURTH: The new jurisdiction whose laws govern its internal affairs is _____________________________________________. All the statements required to be set forth in an Application for Authority are attached as Exhibit _____________. For a Foreign Nonprofit Corporation, attach form MNPCA-12-1. For a Foreign Limited Partnership, attach form MLPA-12-1. For a Foreign Limited Liability Company, attach form MLLC-12-1. For a Foreign Limited Liability Partnership, attach form MLLP-12-1.

DATED _________________________

*By ___________________________________________________
(signature of an officer or other duly authorized representative)

___________________________________________________
(type or print name and capacity)

*This document MUST be signed by an officer or other duly authorized representative. (§1524.1) 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-12C 7-1-2003 TEL. (207) 624-7752