Form Mllc-5 - Statement Of Intention To Transact Business Under An Assumed Or Fictitious Name Page 2

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THIRD:
(Foreign Limited Liability Company Only)
Jurisdiction of organization ______________________________________________________ and the date on which
the limited liability company was authorized to transact business in Maine ___________________________________.
DATED __________________________
*Authorized person(s)
________________________________________________
_______________________________________________
(authorized signature)
(Type or print name of authorized person)
*Pursuant to
31 MRSA
§1676.1B, this statement MUST be signed by a person authorized by the limited liability company.
The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under
17-A MRSA
§453.
Please remit your payment made payable to the Maine Secretary of State.
Submit completed form to:
Secretary of State
Division of Corporations, UCC and Commissions
101 State House Station
Augusta, ME 04333-0101
Telephone Inquiries: (207) 624-7752
Email Inquiries:
CEC.Corporations@Maine.gov
Form No. MLLC-5 (2 of 2) 11/16/2012

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