Free DOMESTIC - Maine

Filing Fee $100.00

STATE OF MAINE

STATEMENT OF APPOINTMENT OF AGENT FOR SERVICE OF PROCESS FOR A NONFILING DOMESTIC ENTITY OR A NONQUALIFIED FOREIGN ENTITY

_____________________ Deputy Secretary of State

A True Copy When Attested By Signature

_____________________ Deputy Secretary of State

Pursuant to 5 MRSA §112 the undersigned entity executes and delivers the following statement of appointment of agent for service of process. FIRST: The name and entity type of the domestic nonfiling or foreign nonqualified entity is: _______________________________________________________________________________ (entity name) _______________________________________________________________________________ (type of entity) SECOND: THIRD: Jurisdiction of organization: _______________________________________ The name and address of the Agent for Service of Process is: ________________________________________________________________________________ (name of agent) ________________________________________________________________________________ (physical address ­ street, city, state and zip code ­ No P.O. Box) FOURTH: The appointment of a registered agent under this section does not qualify a nonqualified foreign entity to do business in the State and is not sufficient alone to create personal jurisdiction over the nonqualified foreign entity in this State. This statement appointing an agent for service of process is effective for a period of 5 years after the date of filing.

FIFTH:

DATED _________________________

*By

______________________________________________ (signature) _______________________________________________ (type or print name and capacity)

*This statement MUST be signed by any duly authorized officer. 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. SOP-APPT 6/15/2009