Form Mbca-12 - Application For Authority To Do Business Form

Form Mbca-12 - Application For Authority To Do Business Form - State Of Maine Page 2

SEVENTH:

Number of shares it has authority to issue, itemized as follows: (attach separate sheet if necessary)

Class

Series

Par Value Per Share

Number of Shares

EIGHTH:

This application is accompanied by an original certificate of good standing, executed by the official in the jurisdiction

of incorporation having custody of the corporate records, stating that the corporation has legal existence, good

standing or similar language and dated not earlier than 90 days prior to the date of delivery for filing of this

application.

DATED _________________________

*By ____________________________________________________

(signature of any duly authorized individual)

____________________________________________________

(type or print name and capacity)

THE FOLLOWING SHALL BE COMPLETED BY THE REGISTERED AGENT UNLESS THIS DOCUMENT IS

ACCOMPANIED BY FORM MBCA-18 (§1212.1-A.).

The undersigned hereby accepts the appointment as registered agent for the above named foreign business corporation.

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)

*This document MUST be signed by any duly authorized individual.

SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,

101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101

FORM NO. MBCA-12 Rev. 4/16/2001

TEL. (207) 624-7740

Form Mbca-12 - Application For Authority To Do Business Form - State Of Maine Page 2