Form Mbca-3-Ncra - Statement Of Appointment Or Change
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1
2Filing Fee $35.00 for each corporation listed
DOMESTIC
BUSINESS CORPORATION
STATE OF MAINE
NONCOMMERCIAL CLERK
_____________________
STATEMENT OF
Deputy Secretary of State
APPOINTMENT or CHANGE
A True Copy When Attested By Signature
_____________________
______________________________________
Deputy Secretary of State
(Name of Corporation as it appears on the records of the Secretary of State)
Pursuant to
5 MRSA §§105,
108, &
109
the undersigned corporation executes and delivers the following statement of appointment
and/or change of address by a noncommercial Clerk.
FIRST:
("X" all boxes that apply)
A.
change of address
B.
change to/of noncommercial clerk and address
C.
change of noncommercial clerk
D.
change in name of current noncommercial clerk
SECOND:
The name and address of the clerk appearing on the record in the Secretary of State's office:
_______________________________________________________________________________________________
(name of current clerk)
_______________________________________________________________________________________________
(physical street address, city, state and zip code)
_______________________________________________________________________________________________
(mailing address if different from above)
THIRD:
Complete this Item as follows based on your selection in Item First:
A.
The new address of the noncommercial clerk (provide address information only);
B.
The name and address of the new noncommercial clerk, who must be a Maine resident (provide name and
address information);
C.
The name of the new noncommercial clerk, who must be a Maine resident (provide name only); OR
D.
The new name of the current noncommercial clerk (provide name only).
_______________________________________________________________________________________________
(name of new noncommercial clerk or new name of current noncommercial clerk)
_______________________________________________________________________________________________
(physical street address, not a P.O. Box – city, state and zip code)
_______________________________________________________________________________________________
(mailing address if different from above)
Form No. MBCA-3-NCRA (1 of 2)
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