Form Mbca-21c - Statement Of Abandonment Of Entity Conversion - State Of Maine
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1Filing Fee $35.00
DOMESTIC
BUSINESS CORPORATION
STATE OF MAINE
STATEMENT OF ABANDONMENT OF
_____________________
ENTITY CONVERSION
Deputy Secretary of State
A True Copy When Attested By Signature
______________________________________
_____________________
(Name of Corporation)
Deputy Secretary of State
Pursuant to
13-C MRSA
§958, the undersigned corporation executes and delivers the following Statement of Abandonment of Entity
Conversion:
FIRST:
The entity conversion is abandoned after articles of entity conversion or articles of charter surrender have been filed
with the Secretary of State but before the entity conversion has become effective on ___________________________.
SECOND:
This statement takes effect upon filing, and the entity conversion is considered abandoned and does not become
effective.
DATED _________________________
*By ___________________________________________________
(signature of an officer or other duly authorized representative)
___________________________________________________
(type or print name and capacity)
*This document MUST be signed by an officer or other duly authorized representative. (§958.2)
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. MBCA-21C 7-1-2003
TEL. (207) 624-7752
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