Form For A Notification By Registered Agent Of Change In Name Or Registered Office Or Both - Domestic Llc Page 2
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1
2REGISTERED AGENT*
DATED
(signature)
(type or print name)
For Registered Agent which is a Corporation
Name of Corporation
By
(aud1orized signamre)
(type or print name aIxl capacity)
*Certificate
~
be signed by the re2istered
aeent (§607.3.B.).
The execution of this certificate constitutes an oath or affirmation
under the penalties of false swearing under Title 17-A, section 453.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MLLC-3B
Rev.7/2000
TEL. (201) 287-4195
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