Filing Fee $5.00
DOMESTIC NONPROFIT CORPORATION
STATE OF MAINE
CHANGE OF CLERK/SECRETARY and/or ADDRESS
_____________________ Deputy Secretary of State
A True Copy When Attested By Signature
______________________________________
(Name of Corporation)
_____________________ Deputy Secretary of State
Pursuant to 13 MRSA §934 the undersigned corporation executes and delivers for filing the following Change of Clerk and/or Address: FIRST: A. C. ("X" all boxes that apply) change of address change of clerk B. D. change of clerk and address change in name of current clerk
SECOND:
The name and address of the clerk appearing on the record in the Secretary of State's office: _______________________________________________________________________________________________
(name of current clerk)
_______________________________________________________________________________________________
(street, city, state and zip code)
THIRD:
Complete this Item as follows based on your selection in Item First: A. B. C. D. The new address (provide address information only); The name and address of the new clerk (provide name and address information); The name of the new clerk (provide name only); OR The new name of the current clerk (provide name only).
_______________________________________________________________________________________________
(name of new clerk or new name of current clerk)
_______________________________________________________________________________________________
(physical location, not P.O. Box street, city, state and zip code)
_______________________________________________________________________________________________
(mailing address if different from above)
FORM NO. MNP-3 (1 of 2)
DATED _________________________
*By ____________________________________________________
(signature)
____________________________________________________
(type or print name and capacity)
*By ____________________________________________________
(signature)
____________________________________________________
(type or print name and capacity)
(1) *This document MUST be signed by the clerk or secretary
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. MNP-3 (1 of 2) 4/18/2006 TEL. (207) 624-7752