Form Mllc-12 - Foreign Limited Liability Company - Statement Of Foreign Qualification To Conduct Activities/filer Contact Cover Letter Template Page 2

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SIXTH:
The Registered Agent is a: (select either a Commercial or Noncommercial Registered Agent)
Commercial Registered Agent
CRA Public Number: ____________________
__________________________________________________________________________________
(name of commercial registered agent)
Noncommercial Registered Agent
__________________________________________________________________________________
(name of noncommercial registered agent)
__________________________________________________________________________________
(physical location, not P.O. Box – street, city, state and zip code)
__________________________________________________________________________________
(mailing address if different from above)
SEVENTH:
Pursuant to
5 MRSA
§105.2, the registered agent listed above has consented to serve as the registered agent for this
limited liability company.
EIGHTH:
The name and business, residence and mailing address of each manager (if any):
NAME
ADDRESS
____________________________________
___________________________________________________
____________________________________
___________________________________________________
____________________________________
___________________________________________________
Names and addresses of additional managers are attached as Exhibit ____, and made a part hereof.
NINTH:
The date on which the foreign limited liability company commenced or expects to commence conducting activities in
the State of Maine is _______________________________.
TENTH:
Check only if applicable
This is a professional limited liability company qualified pursuant to
13 MRSA Chapter 22-A
to provide
the following professional services (see
13 MRSA, chapter 22-A
for information on what constitutes
professional services):
____________________________________________________________________________________________
(type of professional services)
Form No. MLLC-12 (2 of 3)

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