MANAGER(S)/MEMBER(S)*
DATED __________________________
___________________________________________________
____________________________________________________
(signature)
(type or print name and capacity)
For Manager(s)/Member(s) which are Entities
Name of Entity __________________________________________________________________________________________________
By ________________________________________________
____________________________________________________
(authorized signature)
(type or print name and capacity)
IF THIS CERTIFICATE OF CORRECTION NAMES A NEW REGISTERED AGENT, THE FOLLOWING SHALL BE
COMPLETED BY THE REGISTERED AGENT UNLESS THIS DOCUMENT IS ACCOMPANIED BY FORM MLLC-18
(§714.2-A.).
The undersigned hereby accepts the appointment as registered agent for the above-named foreign limited liability company.
REGISTERED AGENT
DATED __________________________
___________________________________________________
____________________________________________________
)
(signature)
(type or print name
For Registered Agent which is a Corporation
Name of Corporation ______________________________________________________________________________________________
By ________________________________________________
____________________________________________________
(authorized signature)
(type or print name and capacity)
*Certificate MUST be signed by
(1) at least one manager OR
(2) if there is no manager, by a member (§716).
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-17A
Rev. 4/16/2001
TEL. (207) 624-7740