Form Mbca-5 - Business Corporation Statement Of Intention To Do Business Under An Assumed Name Page 2

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DATED
*By
(signattlre)
(type or print name and capacity)
*By
(sig11attlre)
(tyPe or print name aIKl capacity)
*If this is a domestic corporation, this document ~
be signed by
(I) the ~
OR
(2) the President or a vice-pres. together with the Secreta" or an ass't. sec., or a 2nd certifying officer OR
(3) if no such officers, then a majority of the Directors OR
(4) if no such directors, then the Holders of a majoritv of all outstandinl! shares OR
(5) the Holders of aIl of the outstanding shares.
*If this is a foreign corporation, this document MUST be signed by any duly authorized individual.
SUBMIT COMPLETED
FORMS TO: CORPORATE EXAMINING
SECnON,
SECRETARY OF STATE,
101 STATE HOUSE STAnON,
AUGUSTA, ME 04333-0101
FORM NO. MBCA-5
Rev.8/2000
TEL.
(201) 287-4195

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