Free MNPCA-11 - Maine

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DOMESTIC NONPROFIT CORPORATION STATE OF MAINE

STATEMENT OF INTENT TO DISSOLVE
(Written Consent of Members or Directors)
_____________________ Deputy Secretary of State

A True Copy When Attested By Signature

______________________________________
(Name of Corporation)

_____________________ Deputy Secretary of State

Pursuant to 13-B MRSA §1101, the undersigned corporation executes and delivers for filing the following Statement of Intent to Dissolve the corporation. FIRST: Title President Treasurer Secretary Clerk Directors: The names and respective addresses of its officers and directors are: Name __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ SECOND: Address ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________

(List additional directors on reverse side)

("X" one box only) Exhibit A attached hereto is a copy of the written consent signed by: All members of the corporation entitled to vote. All directors of the corporation, there being no members or no members entitled to vote.

THIRD: FOURTH:

All required Reports have been filed with the Secretary of State. (Note: If the dissolution process is completed on or before June 1st, then the Report covering the previous calendar year is not required.) The undersigned corporation understands that the filing of this document does not complete the dissolution process. You must also file Articles of Dissolution, form MNPCA-11D or 11E.

FORM NO. MNPCA-11 (1 of 2)

FIFTH:

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

DATED _________________________

*By __________________________________________________
(signature)

__________________________________________________ MUST BE COMPLETED FOR VOTE OF MEMBERS I certify that I have custody of the minutes showing the above action by the members. ____________________________________________
(signature of clerk, secretary or asst. secretary) (type or print name and capacity)

*By __________________________________________________
(signature)

___________________________________________________
(type or print name and capacity)

Notice of the filing of this statement shall be mailed to each known creditor of the corporation pursuant to 13-B MRSA §1101.2.

*This document MUST be signed by any authorized officer. (13-B MRSA §104.1.B)

SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MNPCA-11 (2 of 2) Rev. 9/16/2005 TEL. (207) 624-7752