DATED __________________________
AUTHORIZED SIGNATURE(S)*
___________________________________________________
____________________________________________________
(signature)
(type or print name and capacity)
___________________________________________________
____________________________________________________
(signature)
(type or print name and capacity)
___________________________________________________
____________________________________________________
(signature)
(type or print name and capacity)
For Authorized Signature(s) on behalf of Entities
Name of Entity __________________________________________________________________________________________________
By ________________________________________________
____________________________________________________
(authorized signature)
(type or print name and capacity)
Name of Entity __________________________________________________________________________________________________
By ________________________________________________
____________________________________________________
(authorized signature)
(type or print name and capacity)
Name of Entity __________________________________________________________________________________________________
By ________________________________________________
____________________________________________________
(authorized signature)
(type or print name and capacity)
*Certificate MUST be signed by
(1) all managers OR
(2) if neither the manager nor the members are winding up the limited liability company's affairs, then by all liquidating trustees
OR
(3) if the members are winding up the limited liability company's affairs, then by a majority in interest of the members OR
(4) any duly authorized person.
The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under Title 17-A, section 453.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MLLC-11C
Rev. 4/16/2001
TEL. (207) 624-7740