Form Mbca-12a - Amended Application For Authority To Do Business - State Of Maine Page 2

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DATED
*By
(signature of any duly autlIorized individual)
(type or print name aIxi 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-12A Rev.8/2000
TEL. (201) 287-4195

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