Form Mllc-12 - Foreign Limited Liability Company Application For Authority To Do Business - 2005 Page 3

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Acceptance of Appointment of Registered Agent
The undersigned hereby accepts the appointment as registered agent for the above-named limited liability company.
DATED _______________________________
___________________________________________________
Registered Agent Signature
(
)
___________________________________________________
(type or print name)
For Registered Agent which is a Corporation
Name of Corporation ____________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(Authorized signature)
(type or print name and capacity)
Note: If the registered agent does not sign, Form MLLC-18 (§714.2-A) must accompany this document.
*The professional limited liability company name as used in the State of Maine satisfies the requirements of
13 MRSA §736.
**The limited liability company name as used in the State of Maine must contain one of the following: "Limited Liability Company",
"L.L.C." or "LLC" (§603-A). If the addition of these words is the only difference from the limited liability company's real name in its
jurisdiction of organization, no further action is required.
***Application MUST be signed by at least one authorized person (§712.2).
The execution of this application constitutes an oath or affirmation under the penalties of false swearing under
Title 17-A, section
453.
Please remit your payment made payable to the Maine Secretary of State.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
TEL. (207) 624-7752
FORM NO. MLLC-12 (3 of 3) Rev. 9-16-2005

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