Form Mbca-12 - Application For Authority To Do Business Page 2
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3SIXTH:
The name of its Registered Agent, an individual resident in Maine, a domestic business or nonprofit corporation, a
foreign business or nonprofit corporation authorized to do business or carry on activities in Maine, and the registered
office (which is identical to the business office) in Maine shall be:
_______________________________________________________________________________________________
(name)
_______________________________________________________________________________________________
(physical location, not P.O. Box – street, city, state and zip code)
_______________________________________________________________________________________________
(mailing address if different from above)
SEVENTH:
The names and usual business addresses of its current directors and officers: (Attach additional pages, if necessary.)
___________________________________________________
Street _______________________________________________
(type or print name and capacity)
(street or mailing address)
___________________________________________________
(city, state and zip code)
___________________________________________________
Street ______________________________________________
(type or print name and capacity)
(street or mailing address)
___________________________________________________
(city, state and zip code)
___________________________________________________
Street _______________________________________________
(type or print name and capacity)
(street or mailing address)
___________________________________________________
(city, state and zip code)
___________________________________________________
Street ______________________________________________
(type or print name and capacity)
(street or mailing address)
___________________________________________________
(city, state and zip code)
EIGHTH:
This application is accompanied by a certificate of existence or a document of similar import duly authenticated by the
Secretary of State or other official having custody of corporate records in the state or country under whose law the
foreign corporation is incorporated. The certificate of existence must have been made not more than 90 days prior to
the delivery of this application for filing.
DATED _________________________
*By ___________________________________________________
(signature of any duly authorized officer)
__________________________________________________
(type or print name and capacity)
FORM NO. MBCA-12 (2 of 3)
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