Free 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 - Maine

Filing Fee $5.00

NONPROFIT CORPORATION STATE OF MAINE

TRANSFER OF RESERVED NAME

_____________________ Deputy Secretary of State

A True Copy When Attested By Signature

_____________________ Deputy Secretary of State

Pursuant to 13-B MRSA §302-A.2, the undersigned transferor executes and delivers the following Transfer of Reserved Name: _____________________________________________________________________________________________________________
(Name previously reserved pursuant to §302.-A.1)

Name of original applicant _____________________________________________________________________________________ Name of transferee ____________________________________________________________________________________________ Address of transferee ___________________________________________________________________________________________

ORIGINAL APPLICANT (Transferor) ___________________________________________________
(signature of any duly authorized person)

DATED __________________________ ___________________________________________________
(type or print name and capacity)

This transfer of reserved name will expire 120 days from the date of filing the original application. 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. MNPCA-1A Rev. 7/1/2003 TEL. (207) 624-7752