Form Mbca-12d - Change Of Registered Agent And/or Registered Office
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1
2Filing Fee $35.00 for each corporation listed
FOREIGN
BUSINESS CORPORATION
STATE OF MAINE
CHANGE OF REGISTERED AGENT
_____________________
and/or
Deputy Secretary of State
REGISTERED OFFICE
A True Copy When Attested By Signature
______________________________________
_____________________
Deputy Secretary of State
(Name of Corporation)
Pursuant to
13-C MRSA
§1507, the undersigned corporation executes and delivers the following Change of Registered Agent and/or
R
egistered Office:
FIRST:
("X" all boxes that apply)
A.
change of registered office only
B.
change of registered agent and registered office
C.
change of registered agent only
D.
change in name of current registered agent
SECOND:
(Complete the following if Item First B or C was checked above.)
The jurisdiction of incorporation is
_____________________________ and the date on which the corporation was authorized to transact business in
the State of Maine is ____________________________.
THIRD:
The name and registered office of the registered agent appearing on the record in the Secretary of State's office:
_______________________________________________________________________________________________
(name of current registered agent)
_______________________________________________________________________________________________
(street, city, state and zip code)
FOURTH:
Complete this Item as follows based on your selection in Item First:
A.
The address of the new registered office (provide address information only);
B.
The name and registered office of the new registered agent, who must be a Maine resident or a domestic
business or nonprofit corporation, a foreign business or nonprofit corporation authorized to do business or
carry on activities in Maine (provide name and address information);
C.
The name of the new registered agent, who must be a Maine resident or a domestic business or nonprofit
corporation, a foreign business or nonprofit corporation authorized to do business or carry on activities in
Maine (provide name only); OR
D.
The new name of the current registered agent (provide name only).
_______________________________________________________________________________________________
(name of new registered agent or new name of current registered agent)
_______________________________________________________________________________________________
(physical location, not P.O. Box – street, city, state and zip code)
_______________________________________________________________________________________________
(mailing address if different from above)
NOTE: The business office of the registered agent must be identical with the registered office.
FORM NO. MBCA-12D (1 of 2)
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