Filing Fee $90.00 DOMESTIC BUSINESS CORPORATION STATE OF MAINE ARTICLES OF CHARTER SURRENDER (Upon Nonprofit Conversion) _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Corporation) _____________________ Deputy Secretary of State Pursuant to 13-C MRSA §§934 and 935, 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 conversion of the corporation to a foreign nonprofit corporation and the effective date of the conversion is (date) _____________________________________. SECOND: THIRD: FOURTH: The foreign nonprofit conversion was duly approved by the shareholders 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 conversion and that the domestic 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) 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. DATED _________________________ *By __________________________________________________ (signature of an officer or other duly authorized representative) __________________________________________________ (type or print name and capacity) *This document MUST be signed by an officer or other duly authorized representative. (13-C MRSA §934.1) 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-20A (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