Form Mllc-12b - Cancellation Of Authority To Do Business (Page 2 of 2) in pdf

Form Mllc-12b - Cancellation Of Authority To Do Business Page 2

DATED __________________________

Authorized Signature(s)*

___________________________________________________

)

(signature)

(type or print name and capacity

For Authorized Signature(s) on behalf of Entities

Name of Entity _________________________________________________________________________________________________

By ________________________________________________

___________________________________________________

(authorized signature)

(type or print name and capacity)

*Certificate MUST be signed by:

(1) at least one manager OR

(2) at least one member if the limited liability company is managed by the members OR

(3) 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. MLLC-12B (2 of 2) Rev. 8/1/2004

TEL. (207) 624-7752

Form Mllc-12b - Cancellation Of Authority To Do Business Page 2