Form No. Mllc-12b - Cancellation Of Authority To Do Business August 2000 Page 2

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DATED
AUfHORIZED SIGNATURE(S)*
(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)
*Certificate ~
be signed by
(I)
at least one manager OR
(2)
at least one member if the limited liability company is managed by the members OR
(3)
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. MLLC-12B
Rev.8/2000
TEL. (201) 287-4195

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