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DOMESTIC BUSINESS CORPORATION STATE OF MAINE

STATEMENT OF ABANDONMENT OF 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 §936, the undersigned corporation executes and delivers the following Statement of Abandonment of Nonprofit Conversion: The nonprofit conversion is abandoned after articles of nonprofit conversion or articles of charter surrender have been filed with the Secretary of State but before the nonprofit conversion has become effective on ____________________. SECOND: This statement takes effect upon filing, and the nonprofit conversion is considered abandoned and does not become effective.

FIRST:

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. (§936.2) 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-20B 7-1-2003 TEL. (207) 624-7752