Form Mllc-12-1 - Application For Authority To Do Business - 2005 Page 2
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1
2EIGHTH:
The name and business, residence or mailing address of each manager, if any, is
NAME
ADDRESS
____________________________________
___________________________________________________
____________________________________
___________________________________________________
____________________________________
___________________________________________________
Names and addresses of additional managers are attached hereto as Exhibit ____, and made a part hereof.
NINTH:
The date on which the foreign limited liability company first did, or intends to do, business in the State of Maine is
___________________________________________.
TENTH:
This application is accompanied by a certificate of existence or a document of similar import duly authenticated by the
Secretary of State or other official having custody of limited liability company records in the state or country under
whose law the foreign limited liability company is organized. The certificate of existence must have been made not
more than 90 days prior to the delivery of this application for filing.
Acceptance of Appointment of Registered Agent
The undersigned hereby accepts the appointment as registered agent for the above-named foreign limited liability company.
DATED _______________________________________
___________________________________________________
(Registered Agent Signature)
___________________________________________________
(Type or print name)
For Registered Agent which is a Corporation
Name of Corporation ____________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(Authorized Signature)
(Type or print name and capacity)
Note: If the registered agent does not sign, Form MLLC-18 (§714.2-A) must accompany this document.
* The limited liability company name as used in the State of Maine must contain one of the following: "Limited Liability Company",
"L.L.C." or "LLC" (§603-A). If the addition of these words is the only difference from the limited liability company's real name in its
jurisdiction of organization, no further action is required.
** The professional limited liability company name as used in the State of Maine satisfies the requirements of
13 MRSA §736.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MLLC-12-1 (2 of 2) 9-16-2005
TEL. (207) 624-7740
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