Form No. Mlpa-5 - Statement Of Intention To Do Business Under An Assumed Name August 2000 Page 2
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1
2DATED
GENERAL PARTNER(S)*
(signattlre)
(type or print name)
For General Partner(s) which are Entities
Name of Entity
By
(authorized signattlre)
(type or print name aId capacity)
*Certificate ~
be signed by
(I)
at least one 2eneml Partner OR
(2)
any duly authorized person.
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. MLPA-5
Rev.8/2000
TEL. (201) 287-4195
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