Filing Fee $100.00
STATE OF MAINE
STATEMENT OF APPOINTMENT OF
_____________________
AGENT FOR SERVICE OF PROCESS FOR A
Deputy Secretary of State
NONFILING DOMESTIC ENTITY OR A
NONQUALIFIED FOREIGN ENTITY
A True Copy When Attested By Signature
_____________________
Deputy Secretary of State
Pursuant to
5 MRSA §112
the undersigned entity executes and delivers the following statement of appointment of agent for service of
process.
FIRST:
The name and entity type of the domestic nonfiling or foreign nonqualified entity is:
_______________________________________________________________________________
(entity name)
_______________________________________________________________________________
(type of entity)
SECOND:
Jurisdiction of organization: _______________________________________
THIRD:
The name and address of the Agent for Service of Process is:
________________________________________________________________________________
(name of agent)
________________________________________________________________________________
(physical address – street, city, state and zip code – No P.O. Box)
FOURTH:
The appointment of a registered agent under this section does not qualify a nonqualified foreign entity to do business in
the State and is not sufficient alone to create personal jurisdiction over the nonqualified foreign entity in this State.
FIFTH:
This statement appointing an agent for service of process is effective for a period of 5 years after the date of filing.
DATED _________________________
*By
______________________________________________
(signature)
_______________________________________________
(type or print name and capacity)
*This statement MUST be signed by any duly authorized officer.
Please remit your payment made payable to the Maine Secretary of State.
Submit completed form to:
Secretary of State
Division of Corporations, UCC and Commissions
101 State House Station, Augusta, ME 04333-0101
Telephone Inquiries: (207) 624-7752
Email Inquiries:
CEC.Corporations@Maine.gov
Form No. SOP-APPT 6/15/2009