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Form Mnpca-5a - Termination Of Statement Of Intention To Carryon Activities Under An Assumed Name - State Of Maine

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NONPROFIT CORPORATION

STATE OF MAINE

TERMINATION

OF STATEMENT

OF INTENTION

TO CARRYON

ACTIVITIES

UNDER AN ASSUMED NAME

Deputy Secretary of State

A True Copy When Attested

By Signature

Deputy Secretary of State

(Name of Corporation)

Pursuant to 13-B MRSA §308. 7, the undersigned, a corporation (incorporated under the laws of the State of Maine), (incorporated

under the laws of the State of,

and authorized to carry on activities in Maine), gives the following notice:

FIRST:

The corporation no longer intends to carry on activities under the assumed name of

SECOND:

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

(street, city, state and zip code)

DATED

*By

( signattlre )

(type or print name aIxi capacity)

*By

(signature)

(type or print name and capacity)

*If this is a domestic corporation, this document ~

be signed by

(I) the ~

or Secretarv OR

(2) the President or a vice-pres. together with the Secretarv or an ass't. sec., or a 2nd certifying officer OR

(3) if no such officers, then a majority of the Directors OR

(4) if no such directors, then the Members.

*If this is a foreign corporation, this document MUST be signed by any duly authorized individual.

SUBWT COMPLETED

FORMS TO: CORPORATE EXAMINING

SECTION, SECRETARYOF

STATE,

101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101

FORM NO. MNPCA-5A

Rev.8/2000

TEL. (207} 287-4195

Form Mnpca-5a - Termination Of Statement Of Intention To Carryon Activities Under An Assumed Name - State Of Maine

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