Form Mllc-12c - Form For Change Of Registered Agent And/or Registered Office (Page 2 of 2) in pdf

Form Mllc-12c - Form For Change Of Registered Agent And/or Registered Office Page 2

DATED

MANA GER(S)/MEMBER(S) *

(signature)

(type or print name aOO capacity)

For Manager(s)/Member(s) which are Entities

Name of Entity

(audlorized signattlre)

(type or print name aIxl capacity)

THE

FOLLOWING

SHALL

COMPLETED

THE

REGISTERED

AGENT

UNLESS

TInS

DOCUMENT

ACCOMPANIED

BY FORM

MLLC-18

(§714.2-A.).

The undersigned hereby accepts the appointment as registered agent for the above-named limited liability

company.

REGISTERED AGENT

DATED

(signature)

(type or print name)

For Registered Agent which is a Corporation

Name of Corporation

(audlorized signature)

(tyPe or print name aIxl capacity)

*Certificate ~

be signed by

(I)

at least one mana~er OR

(2)

if there is no manager, by a member (§721.1.).

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-12C Rev.7/2000

TEL. (207) 287-4195

Form Mllc-12c - Form For Change Of Registered Agent And/or Registered Office Page 2