Form Mlpa-11t - Certificate Of Amendment By Liquidating Trustees 2004 Page 2
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1
2DATED __________________________
Liquidating Trustee(s)*
___________________________________________________
___________________________________________________
)
(signature)
(type or print name
___________________________________________________
___________________________________________________
(signature)
(type or print name)
___________________________________________________
___________________________________________________
(signature)
(type or print name)
For Liquidating Trustee(s) which are Entities
Name of Entity _________________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
Name of Entity _________________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
Name of Entity _________________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
*Certificate MUST be signed by:
(1) all liquidating trustees OR
(2) any duly authorized person.
The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under
17-A MRSA
§453.
Please remit your payment made payable to the Maine Secretary of State.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MLPA-11T (2 of 2) Rev. 8/1/2004
TEL. (207) 624-7752
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