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Form Mbca-8a - Statement Of Cancellation Of Reacquired Shares - Maine Secretary Of State

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Fee

$20.00

DOMESTIC

BUSINESS CORPORATION

STATE OF MAINE

STATEMENT OF CANCELLATION

OF REACQUIRED SHARES

Deputy Secretary of State

A True Copy When Attested

By Signature

Deputy Secretary of State

(Name of Corporation)

Pursuant to 13-A MRSA §521.3, the undersigned corporation submits the following statement of cancellation by resolution of its board

of directors of shares of the corporation reacquired by it, other than redeemable shares redeemed or purchased:

FIRST:

The number of reacquired shares cancelled by resolution adopted by the board of directors on (date)

itemized by classes and series are as follows:

Number of Shares

SECOND:

The number of shares which the corporation has authority to issue, after giving effect to such cancellation, itemized

by classes and series are as follows:

Number of Shares

The aggregate par value of all such shares (of all classes and series) havinJ! oar value is $

THIRD:

The total number of all such shares (of all classes and series) without oar value is

FOURm:

The address of the registered office of the corporation in the State of Maine is

(street,

city,

state am

zip code)

Form Mbca-8a - Statement Of Cancellation Of Reacquired Shares - Maine Secretary Of State