Form Mnpca-12b - Application For Surrender Of Authority To Carryon Activities

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FOREIGN
NONPROFIT CORPORATION
STATE OF MAINE
APPLICATION
FOR
SURRENDER OF AUTHORITY
TO CARRYON
ACTIVITIES
(Name of Corporation)
Pursuant to 13-B MRSA §1208, the undersigned foreign corporation hereby executes and delivers for fIling this Application for
Surrender of Authority to Carry on Activities in the State of Maine:
FIRST:
The jurisdiction of its incorporation is
SECOND:
The date on which it was authorized to carry on activities in the State of Maine is
TIllRD:
The corporation
is not as of the date of this application carrying on activities in the State of Maine and surrenders its
authority to carry on activities in the state.
FOUR111:
The corporation revokes the authority of its registered agent in the State of Maine to accept service of process; it
consents that process in any action, suit or proceeding based upon any cause of action arising in the State of Maine
prior to the date of fIling this application may be served on the Secretary of State after the date of the fIling of this
application.
FIFfH:
The post-office address to which the Secretary of State shall mail a copy of any process served upon him against the
corporation is
(street, city, state and zip code)
SIXTH:
The address of the principal or registered office of the corporation, wherever located, is
(street. city, state aOO zip code)

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