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DOMESTIC BUSINESS CORPORATION STATE OF MAINE

ARTICLES OF CHARTER SURRENDER
(Upon Nonprofit Conversion)

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

______________________________________
(Name of Corporation)

_____________________ Deputy Secretary of State

Pursuant to 13-C MRSA §§934 and 935, the undersigned corporation executes and delivers the following Articles of Charter Surrender: FIRST: The articles of charter surrender are being filed in connection with the conversion of the corporation to a foreign nonprofit corporation and the effective date of the conversion is (date) _____________________________________. SECOND: THIRD: FOURTH: The foreign nonprofit conversion was duly approved by the shareholders in the manner required by this Act and the corporation's articles of incorporation. The corporation's new jurisdiction of incorporation is ___________________________________________________. The corporation shall appoint the Secretary of State as its agent for service of process in a proceeding to enforce the rights of shareholders who exercise appraisal rights in connection with the conversion and that the domestic business corporation shall provide a mailing address to which the Secretary of State may mail a copy of any process served on the Secretary of State. _______________________________________________________________________________________________
(mailing address)

FIFTH:

The corporation agrees that it will promptly pay the amount, if any, to which the shareholders are entitled under chapter 13 of Title 13-C.

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. (13-C MRSA §934.1) 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-20A (1 of 1) Rev. 8/1/2004 TEL. (207) 624-7752