Form Mllc-12 Application For Authority To Do Business 2008 Page 3
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3TENTH:
(For professional limited liability companies only)
All of the professional limited liability companies’ members and managers, if any, are licensed in one or more states to
render a professional service disclosed in its application.
ELEVENTH:
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.
Dated ______________________________
___________________________________________________
(Authorized 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)
*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"
(31 MRSA
§603-A). If the addition of these words is the only difference from the limited liability company's real
n
ame in its jurisdiction of organization, no further action is required.
**Application MUST be signed by at least one authorized person
(31 MRSA
§712.2).
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 Maine Secretary of State.
Submit completed form to:
Secretary of State
Division of Corporations, UCC and Commissions
101 State House Station
Augusta, ME 04333-0101
Telephone Inquiries: (207) 624-7752
Email Inquiries:
CEC.Corporations@Maine.gov
Form No. MLLC-12 (3 of 3) Rev. 10/1/2008
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