Form Mbca-12c - Change Of Registered Agent Only Or Change Of Registered Agent And Registered Office Page 2
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1
2DATED
*By
(signature of any duly authorized individual}
(type or print name and capacity)
THE
FOLLOWING
SHALL
BE
COMPLETED
BY
THE
REGISTERED
AGENT
UNLESS
TIllS
DOCUMENT
IS
ACCOMPANIED
BY FORM
MBCA-18
(§1212.1-A.).
The undersigned hereby accepts the appointment as registered agent for the above named foreign business corporation.
REGISTERED AGENT
DATED
(type or print name)
(signamre)
For Registered Agent which is a Corporation
Name of Corporation
By
(authorized signattlre)
(type or print name and 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-12C Rev.8/2000
TEL. (207) 287-4195
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