Form Mnpca-5a - Termination Of Statement Of Intention To Carry On Activities Under An Assumed Or Fictitious Name
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1Filing Fee $5.00
NONPROFIT CORPORATION
STATE OF MAINE
TERMINATION OF STATEMENT OF
_____________________
INTENTION TO CARRY ON ACTIVITIES
Deputy Secretary of State
UNDER AN ASSUMED OR
FICTITIOUS NAME
A True Copy When Attested By Signature
______________________________________
_____________________
Deputy Secretary of State
(Real Name of Corporation)
Pursuant to 13-B MRSA §308-A.8, the undersigned corporation executes and delivers the following Termination of Statement of
Intention to Carry on Activities Under an Assumed or Fictitious Name:
The corporation no longer intends to carry on activities under an assumed or fictitious name.
FIRST:
SECOND:
The corporation intends to terminate the assumed or fictitious name of
______________________________________________________________________________________________.
THIRD:
The address of the registered office of the corporation in the State of Maine is ________________________________
______________________________________________________________________________________________.
(street, city, state and zip code)
DATED _________________________
*By ___________________________________________________
(signature)
__________________________________________________
(type or print name and capacity)
*By __________________________________________________
(signature)
__________________________________________________
(type or print name and capacity)
*If this is a domestic corporation, this document MUST be signed by
(1) the Clerk or Secretary OR
(2) the President or a vice-pres. together with the Secretary or an ass’t. sec., 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.
*If this is a foreign corporation, this document MUST be signed by any duly authorized individual.
Please remit your payment made payable to the Maine Secretary of State.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MNPCA-5A Rev. 7/1/2003
TEL. (207) 624-7740
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