Form Mlpa-12c - Change Of Registered Agent And/or Registered Office - 2004 Page 2

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FOURTH:
The undersigned registered agent of the following limited partnership(s), who has changed the address of the registered
office OR who has changed his or her name, has notified each limited liability partnership of the change indicated in
Item Third A or D:
Name of Limited Partnership
Jurisdiction
Date Authorized to Transact
Business in Maine
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Names of additional limited partnerships attached hereto as Exhibit ___, and made a part hereof.
Note:
The following must be signed by the proper person as designated below.*
DATED _________________________
*By ____________________________________________________
(signature)
____________________________________________________
(type or print name and capacity)
Acceptance of Appointment of New Registered Agent
The undersigned hereby accepts the appointment as registered agent for the above-named limited partnership.
Registered Agent
DATED __________________________
___________________________________________________
__________________________________________________
)
(signature)
(type or print name
For Registered Agent which is a Corporation
Name of Corporation ____________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
Note:
If this document changes the Registered Agent and the new Registered Agent does not sign this form, then
Form MLPA-18
(31 MRSA §494.2-A
must accompany this document.
)
*This certificate MUST be signed as follows:
(1) if Item First, A. was selected, then by the Registered Agent OR
(2) if Item First, B. or C. was selected, at least by at least one general partner
(31 MRSA §499)
OR
(3) if Item First, D. was selected, then by the Registered Agent.
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-12C (2 of 2) Rev. 8/1/2004
TEL. (207) 624-7752

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