Filing Fee $90.00 DOMESTIC BUSINESS CORPORATION STATE OF MAINE ARTICLES OF CHARTER SURRENDER (Upon Domestication) _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Corporation) _____________________ Deputy Secretary of State Pursuant to 13-C MRSA §§924 and 925, the undersigned corporation executes and delivers the following Articles of Charter Surrender: FIRST: The articles of charter surrender are being filed in connection with the domestication of the corporation in a foreign jurisdiction and the effective date of the domestication is (date) ___________________________________________. SECOND: The domestication was duly approved by the shareholders and, if voting by any separate voting group was required, by each such separate voting group, in the manner required by this Act and the corporation's articles of incorporation. The corporation's new jurisdiction of incorporation is ___________________________________________________. The corporation shall appoint the Secretary of State as its agent for service of process in a proceeding to enforce the rights of shareholders who exercise appraisal rights in connection with the domestication and that the foreign business corporation shall provide a mailing address to which the Secretary of State may mail a copy of any process served on the Secretary of State. _______________________________________________________________________________________________ (mailing address) THIRD: FOURTH: FIFTH: The corporation agrees that it will promptly pay the amount, if any, to which the shareholders are entitled under chapter 13 of Title 13-C. *By __________________________________________________ (signature of an officer or other duly authorized representative) DATED _________________________ __________________________________________________ (type or print name and capacity) *This document MUST be signed by an officer or other duly authorized representative. (13-C MRSA §924.1) Please remit your payment made payable to the Maine Secretary of State. SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MBCA-19A (1 of 1) Rev. 8/1/2004 TEL. (207) 624-7752 American LegalNet, Inc. www.FormsWorkFlow.com Filer Contact Cover Letter To: Department of the Secretary of State Division of Corporations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101 Tel. (207) 624-7752 Name of Entity (s): _______________________________________________________________________ _______________________________________________________________________ List type of filing(s) enclosed (i.e. Articles of Incorporation, Articles of Merger, Articles of Amendment, Certificate of Correction, etc.) Attach additional pages as needed. ________________________________________________________________________ ________________________________________________________________________ Special handling request(s): (check all that apply) Hold for pick up Expedited filing - 24 hour service ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 additional filing fee per entity, per service) Total filing fee(s) enclosed: $ ________________ Contact Information ­ questions regarding the above filing(s), please call or email: (failure to provide a contact name and telephone number or email address will result in the return of the erroneous filing (s) by the Secretary of State's office) ___________________________________ (Name of contact person) ___________________________________ (Daytime telephone number) ____________________________________________________ (Email address) The enclosed filing(s) and fee(s) are submitted for filing. Please return the attested copy to the following address: ______________________________________________________________________________ (Name of attested recipient) _____________________________________________________________________________________________ (Firm or Company) _____________________________________________________________________________________________ (Mailing Address) _____________________________________________________________________________________________ (City, State & Zip) American LegalNet, Inc. www.FormsWorkFlow.com