Free MBCA-12E-NCRA - Maine

Filing Fee $35.00

FOREIGN BUSINESS CORPORATION

STATE OF MAINE

NONCOMMERCIAL REGISTERED AGENT STATEMENT OF RESIGNATION

_____________________ Deputy Secretary of State

A True Copy When Attested By Signature

______________________________________
(Name of Corporation)

_____________________ Deputy Secretary of State

Pursuant to 5 MRSA §111, the undersigned noncommercial registered agent executes and delivers the following statement of resignation from serving as agent for service of process for this corporation: FIRST: The name and address of the resigning noncommercial registered agent as it appears on the record in the Secretary of State's office: _______________________________________________________________________________________________ (name of current noncommercial registered agent) _______________________________________________________________________________________________ (physical street address, city, state and zip code ­ as it appears on the record) SECOND: The name and address of the person to which the noncommercial registered agent will send the required notice to: ______________________________________________________________________________________________ (insert name) at_____________________________________________________________________________________________ (mailing address including zip code) the ________________________________________________________________ of the corporation. (title of corporate officer) DATED _________________________ __________________________________________________ (signature of noncommercial registered agent) __________________________________________________ (type or print name) Pursuant to 5 MRSA §111.3, the registered agent shall promptly furnish the represented entity notice in a record of the date on which a statement of resignation was filed. 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-12E-NCRA 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)