Filing Fee $70.00 (If amending ONLY Item FOURTH filing fee $35.00) FOREIGN BUSINESS CORPORATION STATE OF MAINE AMENDED APPLICATION FOR AUTHORITY TO DO BUSINESS _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Corporation) _____________________ Deputy Secretary of State Pursuant to 13-C MRSA §1504, the undersigned foreign corporation executes and delivers the following Amended Application for Authority to do Business: FIRST: SECOND: THIRD: The jurisdiction currently appearing on the record is ___________________________________________________. The date on which it was authorized to do business in the State of Maine is _________________________________. The name of the foreign corporation has been changed to (if no change, so indicate): ______________________________________________________________________________________________. If the real corporate name is not available, the fictitious name under which it proposes to apply for authority to do business in the State of Maine is (if not applicable, so indicate): ______________________________________________________________________________________________. Form MBCA-5 accompanies this application. A fictitious name is a name adopted by a foreign corporation authorized to transact business in this State because its real name is unavailable pursuant to 13-C MRSA §401. FOURTH: The new address of its principal office, wherever located, is (if no change, so indicate): _______________________________________________________________________________________________ (street, city, state and zip code) _______________________________________________________________________________________________ (mailing address if different from above) FIFTH: The new state or country under whose law the foreign corporation is now incorporated (if no change, so indicate): _______________________________________________________________________________________________ A certificate of existence or a document of similar import duly authenticated by the Secretary of State or other official having custody of corporate records in the state or country under whose law the foreign corporation is now incorporated accompanies the change in Item FIFTH. The certificate of existence must have been made not more than 90 days prior to the delivery of this application for filing. American LegalNet, Inc. www.FormsWorkFlow.com FORM NO. MBCA-12A (1 of 2) SIXTH: Other amendments to the application, if any, are set forth in Exhibit ____ attached hereto and made a part hereof. DATED _________________________ *By ___________________________________________________ (signature of any duly authorized officer) __________________________________________________ (type or print name and capacity) *This document MUST be signed by any duly authorized officer. (13-C MRSA §121.5) 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-12A (2 of 2) Rev. 5/17/2010 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