Form Mnpca-11a - Statement Of Intent To Dissolve Page 2
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1
2NUMBER
NUMBER
THIRD:
Number of Members/Directors
Voted
Voted
and Entitled to Vote
For
Against
Totals
FOURTH:
All required Reports have been filed with the Secretary of State. (Note: If the dissolution process is completed on or
before June 1st, then the Report covering the previous calendar year is not required.)
FIFTH:
The undersigned corporation understands that the filing of this document does not complete the dissolution process.
You must also file Articles of Dissolution, Form
MNPCA-11D
or 11E.
SIXTH:
The address of the registered office of the corporation in the State of Maine is _______________________________
_______________________________________________________________________________________________
(street, city, state and zip code)
DATED _________________________
*By __________________________________________________
(signature)
__________________________________________________
MUST BE COMPLETED FOR VOTE
(type or print name and capacity)
OF MEMBERS
*By __________________________________________________
I certify that I have custody of the minutes showing
(signature)
the above action by the members.
__________________________________________________
(type or print name and capacity)
____________________________________________
(signature of clerk, secretary or asst. secretary)
Notice of the filing of this statement shall be mailed to each known creditor of the corporation pursuant to
13-B MRSA §1101.2.
*This document MUST be signed by:
(13-B MRSA
§104.1.B)
(1) the Clerk or Secretary OR
(2) the President or a Vice-President together with the Secretary or an assistant secretary, or a 2nd certifying officer OR
(3) if no such officers, then a majority of the Directors OR
(4) if no such directors, then the Members.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MNPCA-11A (2 of 2) Rev. 8/1/2004
TEL. (207) 624-7740
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