Free MLLC-5 - Maine

Filing Fee for an Assumed Name $125.00 Filing Fee for a Fictitious Name $40.00

LIMITED LIABILITY COMPANY STATE OF MAINE

STATEMENT OF INTENTION TO DO BUSINESS UNDER AN ASSUMED OR FICTITIOUS NAME

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

______________________________________
(Real Name of Limited Liability Company)

Pursuant to 31 MRSA §605-A, the undersigned limited liability company executes and delivers the following Statement of Intention to do Business Under an Assumed or Fictitious Name: FIRST: ("X" one box only.) assumed name (§605-A.1) fictitious name (§605-A.2)

The limited liability company intends to transact business under the assumed or fictitious name of ______________________________________________________________________________________________. Note: A fictitious name is a name adopted by a foreign limited liability company authorized to transact business in this State because its real name is unavailable pursuant to §603-A. Complete the following if applicable: SECOND: If such assumed name is to be used at fewer than all of the limited liability company's places of business in this State, the location(s) where it will be used is (are): ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Additional locations are attached hereto as Exhibit ___, and made a part hereof. THIRD: (Foreign Limited Liability Company Only) Jurisdiction of organization _____________________________________________________ and the date on which the limited liability company was authorized to transact business in Maine __________________________________.

FORM NO. MLLC-5 (1 of 2)

DATED __________________________

Manager(s)/Member(s)* ___________________________________________________
(signature)

___________________________________________________
(type or print name and capacity)

For Manager(s)/Member(s) which are Entities Name of Entity _________________________________________________________________________________________________ By ________________________________________________
(authorized signature)

___________________________________________________
(type or print name and capacity)

*Certificate MUST be signed by: (1) at least one manager OR (2) at least one member if the limited liability company is managed by the members OR (3) any duly authorized person. The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under 17-A MRSA §453. 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. MLLC-5 (2 of 2) Rev. 8/1/2004 TEL. (207) 624-7752