Free MNPCA-12B - Maine

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FOREIGN NONPROFIT CORPORATION STATE OF MAINE

APPLICATION FOR SURRENDER OF AUTHORITY TO CARRY ON ACTIVITIES

Deputy Secretary of State A True Copy When Attested By Signature

______________________________________
(Name of Corporation)

Deputy Secretary of State

Pursuant to 13-B MRSA §1208, the undersigned foreign corporation hereby executes and delivers for filing this Application for Surrender of Authority to Carry on Activities in the State of Maine: FIRST: SECOND: THIRD: The jurisdiction of its incorporation is _________________________________________________________________ The date on which it was authorized to carry on activities in the State of Maine is ____________________________ The corporation is not as of the date of this application carrying on activities in the State of Maine and surrenders its authority to carry on activities in the state. The corporation revokes the authority of its registered agent in the State of Maine to accept service of process; it consents that process in any action, suit or proceeding based upon any cause of action arising in the State of Maine prior to the date of filing this application may be served on the Secretary of State after the date of the filing of this application. The post-office address to which the Secretary of State shall mail a copy of any process served upon him against the corporation is _____________________________________________________________________________________
(street, city, state and zip code)

FOURTH:

FIFTH:

SIXTH:

The address of the principal or registered office of the corporation, wherever located, is _________________________________________________________________________________________________
(street, city, state and zip code)

DATED _________________________

*By ____________________________________________________
(signature of any duly authorized individual)

_____________________________________________________
(type or print name and capacity)

*This document MUST be signed by any duly authorized individual. SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MNPCA-12B Rev. 4/16/2001 TEL. (207) 624-7752