Filing Fee $35.00
DOMESTIC BUSINESS CORPORATION
STATE OF MAINE
NONCOMMERCIAL CLERK STATEMENT OF RESIGNATION
_____________________ Deputy Secretary of State
A True Copy When Attested By Signature
______________________________________
(Name of Corporation as it appears on the records of the Secretary of State)
_____________________ Deputy Secretary of State
Pursuant to 5 MRSA §111, the undersigned noncommercial clerk executes and delivers the following statement of resignation from serving as agent for service of process for this corporation: FIRST: The name and address of the resigning noncommercial clerk as it appears on the record in the Secretary of State's office: _______________________________________________________________________________________________ (name of current noncommercial clerk) _______________________________________________________________________________________________ (physical street address, city, state and zip code as it appears on the record) SECOND: The name and address of the person to which the noncommercial clerk will send the required notice to: ______________________________________________________________________________________________ (insert name) at_____________________________________________________________________________________________ (mailing address including zip code) the ________________________________________________________________ of the corporation. (title of corporate officer) DATED _________________________ __________________________________________________ (signature of noncommercial clerk) __________________________________________________ (type or print name) Pursuant to 5 MRSA §111.3, the clerk shall promptly furnish the represented entity notice in a record of the date on which a statement of resignation was filed. Please remit your payment made payable to the Maine Secretary of State. Submit completed form to: Secretary of State Division of Corporations, UCC and Commissions 101 State House Station, Augusta, ME 04333-0101 Telephone Inquiries: (207) 624-7752 Email Inquiries: [email protected]
Form No. MBCA-3A-NCRA 7/1/2008
Filer Contact Cover Letter
To:
Department of the Secretary of State Division of Corporations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101
Tel. (207) 624-7752
Name of Entity (s): _______________________________________________________________________ _______________________________________________________________________ List type of filing(s) enclosed (i.e. Articles of Incorporation, Articles of Merger, Articles of Amendment, Certificate
of Correction, etc.) Attach additional pages as needed.
________________________________________________________________________ ________________________________________________________________________ Special handling request(s): (check all that apply) Hold for pick up Expedited filing - 24 hour service ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 additional filing fee per entity, per service) Total filing fee(s) enclosed: $ ________________ Contact Information questions regarding the above filing(s), please call or email: (failure to provide a contact name and telephone number or email address will result in the return of the erroneous filing (s) by the Secretary of State's office) ___________________________________
(Name of contact person)
___________________________________
(Daytime telephone number)
____________________________________________________
(Email address)
The enclosed filing(s) and fee(s) are submitted for filing. Please return the attested copy to the following address:
______________________________________________________________________________
(Name of attested recipient)
_____________________________________________________________________________________________
(Firm or Company)
_____________________________________________________________________________________________
(Mailing Address)
_____________________________________________________________________________________________
(City, State & Zip)