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DOMESTIC NONPROFIT CORPORATION STATE OF MAINE

APPLICATION FOR EXCUSE
Deputy Secretary of State A True Copy When Attested By Signature

______________________________________
(Name of Corporation)

Deputy Secretary of State

Pursuant to 13-B MRSA §1301.5, the undersigned corporation executes and delivers for filing this Application for Excuse: President Treasurer Clerk or Secretary
(circle title)

I,

of the above named corporation, a corporation duly organized under the laws of the State of Maine, certify that said corporation ceased to carry on activities on (date) ___________________. Application is made to be excused from further filing an annual report with the Secretary of State of Maine, so long as the corporation in fact carries on no activities. I further certify that all required Annual Reports have been filed with the Secretary of State. (Note: If the excuse process is completed on or before June 1st, then the Annual Report covering the previous calendar year is not required.)

DATED _________________________

_____________________________________________________
(signature)

NOTE: The excuse is effective upon acceptance by the Office of the Secretary of State.

SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MNPCA-14 Rev. 4/16/2001 TEL. (207) 624-7752