Form Mbca-12d - Notification By Registered Agent Of Change In Current Name Or Registered Office For A Foreign Business Corporation Page 2

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DATED
*
(signature of registered agent)
(tyPe
or
print
name)
*
(name of corporation)
By
(signature of any duly authorized individual)
(type or print name aIK1 capacity)
*If the registered agent is a person, it must be manually signed.
If the registered agent is a corporation,
the name of the corporation
should be typed or printed, and 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-12D Rev.8/2000
TEL. (201) 287-4195

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