Form Mbca-12b - Application For Surrender Of Authority To Do Business - Maine Secretary Of State
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FOREIGN
BUSINESS
CORPORATION
STATE OF MAINE
APPLICATION
FOR
SURRENDER OF AUTHORITY
TO DO BUSINESS
Deputy Secretary of State
A True Copy When
Attested
By Signature
Deputy Secretary of State
(Name of Corporation)
Pursuant to 13-A MRSA §1208, the undersigned foreign corporation hereby surrenders its authority to do business in the State of
Maine :
FIRST:
The jurisdiction of its incorporation is
SECOND:
The date on which it was authorized to do business in the State of Maine is
THIRD:
The corporation
is not as of the date of this application doing business in the State of Maine and surrenders its
authority to do business in the state.
FOURm:
The corporation revokes the authority of its registered agent in the State of Maine to accept service of process; it
consents that process in any action, suit or proceeding based upon any cause of action arising in the State of Maine
prior to the date of fIling this application may be served on the Secretary of State after the date of the filing of this
application.
~.D.l.H:
The post-office address to which the Secretary of State shall mail a copy of any process served upon him against the
corporation is
(street, city, state and zip code)
SIXTH:
The address of the principal or registered office of the corporation, wherever located, is
(street, city, state aOO zip code)
DATED
*By
(signamre of any duly authorized individual)
(tyPe or print name and capacity)
*This document ~
be signed by any duly authorized individual
SUBMIT COMPLETED
FORMS TO: CORPORATE EXAMINING
SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MBCA-12B Rev.8/2000
TEL.
(201) 287-4195
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