Free MLLC-13A - Maine

Filing Fee $85.00 for domestic; $150.00 for foreign

LIMITED LIABILITY COMPANY STATE OF MAINE

AMENDED ANNUAL REPORT

______________________________________
(Name of Limited Liability Company)

_____________________ Deputy Secretary of State

Pursuant to 31 MRSA §757-A, the undersigned limited liability company executes and delivers the following Amended Annual Report: FIRST: SECOND: THIRD: The jurisdiction of its organization is _________________________________________________________________. The original annual report was filed on (date) ___________________________________. The information has changed as follows (attach additional pages, if necessary): ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ FOURTH: · · This information changed on (date) _______________________________.

An amended annual report may be filed by the limited liability company to change information currently on file. The time for filing an amended annual report is from the date of the original filing until December 31st of that filing year. If you are changing a member or manager, you must provide the name, title and complete physical address of this individual. Additionally, you must provide the information currently on file and indicate how it changed.

FORM NO. MLLC-13A (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 REPORTING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MLLC-13A (2 of 2) 8/23/2006 TEL. (207) 624-7752