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

Filing Fee $15.00

FOREIGN NONPROFIT CORPORATION STATE OF MAINE

AMENDED APPLICATION FOR AUTHORITY TO CARRY ON ACTIVITIES

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

______________________________________
(Name of Corporation)

_____________________ Deputy Secretary of State

Pursuant to 13-B MRSA §1207, the undersigned foreign corporation executes and delivers the following Amended Application for Authority to Carry on Activities: FIRST: SECOND: THIRD: The jurisdiction of its incorporation is ______________________________________________________________. The date on which it was authorized to carry on activities in the State of Maine is __________________________. The proposed amendment to its application of authority is ______________________________________________ ______________________________________________________________________________________________. FOURTH: The corporate name of the corporation has been changed to (If no change, so indicate.) ________________________ __________________________________________________________________ under the laws of its jurisdiction of incorporation on ______________.
(date)

FIFTH:

If the real corporate name is not available, the fictitious name under which it proposes to apply for authority to carry on activities in the State of Maine is (If not applicable, so indicate.) ______________________________________________________________________________________________. Form MNPCA-5 accompanies this application. A fictitious name is a name adopted by a foreign corporation authorized to carry on activities in this State because its real name is unavailable pursuant to 13-B MRSA §301-A.

SIXTH:

The activity (activities) which it seeks to pursue in the State of Maine is (are) authorized by the laws of its jurisdiction of incorporation and consist(s) of (If no change, so indicate.) _____________________________________________ _______________________________________________________________________________________________ ______________________________________________________________________________________________.

FORM NO. MNPCA-12A (1 of 2)

SEVENTH:

The new address of its registered or principal office, wherever located, is (If no change, so indicate.) ______________________________________________________________________________________________.
(street, city, state and zip code)

EIGHTH:

The address of the registered office of the corporation in the State of Maine is _______________________________ ______________________________________________________________________________________________.
(street, city, state and zip code)

DATED _________________________

*By ___________________________________________________
(signature of any duly authorized individual)

___________________________________________________
(type or print name and capacity)

*This document MUST be signed by any duly authorized individual. 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-12A (2 of 2) Rev. 4/1/2009 TEL. (207) 624-7740