DATED __________________________
Authorized Signature(s)*
___________________________________________________
___________________________________________________
(signature)
(type or print name and capacity)
___________________________________________________
___________________________________________________
(signature)
(type or print name and capacity)
___________________________________________________
___________________________________________________
(signature)
(type or print name and capacity)
For Authorized Signature(s) on behalf of Entities
Name of Entity _________________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
Name of Entity _________________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
Name of Entity _________________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
*Certificate MUST be signed by
(1) if the partners are winding up the registered limited liability partnership's affairs, then by the contact partner or by a
majority in interest of the partners OR
(2) if the partners are not winding up the registered limited liability partnership's affairs, then by all liquidating trustees OR
(3) any duly authorized person.
The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under
17-A MRSA
§453.
Please remit your payment made payable to the Secretary of State.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MLLP-11R (2 of 2) Rev. 8/1/2004
TEL. (207) 624-7752