Filing Fee $250.00 FOREIGN BUSINESS CORPORATION STATE OF MAINE APPLICATION FOR AUTHORITY TO DO BUSINESS (Check box only if applicable.) This is a professional corporation pursuant to 13 MRSA Chapter 22-A.** (see footnote) _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Corporation in Jurisdiction of Incorporation) _____________________ Deputy Secretary of State Pursuant to 13-C MRSA §1503, the undersigned corporation executes and delivers the following Application for Authority to do Business: FIRST: If the legal corporate name does not meet the requirements pursuant to §401 and/or 13 MRSA Chapter 22-A §736 (if a professional corporation) a fictitious name under which it proposes to apply for authority to do business in the State of Maine is: (If not applicable, so indicate.) If using a fictitious name, form MBCA-5 must be included. ____________________________________________________________________________________________ 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 §401. SECOND: 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) THIRD: Pursuant to 5 MRSA §108.3, the new commercial registered agent listed above has consented to serve as the registered agent for this corporation. (For professional corporations only) All of the professional corporation's shareholders, not less than a majority of its directors and all of its officers other than its clerk, secretary and treasurer, if any, are licensed in one or more states to render a professional service described in its articles of incorporation. FOURTH: Form No. MBCA-12 (1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com FIFTH: Its jurisdiction of incorporation is _________________________________ (state or country) and the date of incorporation is ______________________. SIXTH: Address of the principal office, wherever located, is: _______________________________________________________________________________________________ (street, city, state and zip code) _______________________________________________________________________________________________ (mailing address if different from above) SEVENTH: The names and usual business addresses of its current directors and officers: (Attach additional pages, if necessary.) ______________________________________________ Street ___________________________________________ (type or print name and capacity) (street or mailing address) ___________________________________________ (city, state and zip code) ______________________________________________ Street ___________________________________________ (type or print name and capacity) (street or mailing address) __________________________________________ (city, state and zip code) ______________________________________________ Street ___________________________________________ (type or print name and capacity) (street or mailing address) __________________________________________ (city, state and zip code) EIGHTH: This application must be accompanied by 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 incorporated. The certificate of existence must have been made not more than 90 days prior to the delivery of this application for filing. Dated __________________________ *By ___________________________________________________ (original signature of an officer) ___________________________________________________ (type or print name and capacity/title) **The professional corporation name as used in the State of Maine must contain one of the following: "chartered," "professional corporation," "professional association" or "service corporation" or the abbreviation "P.C.," "P.A." or "S.C.". If the legal name in your jurisdiction doesn't require the use of these words, you must file a fictitious name. (See item first) *This document MUST be originally 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 form to: Secretary of State Division of Corporations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101 Telephone Inquiries: (207) 624-7752 Email Inquiries: CEC.Corporations@Maine.gov American LegalNet, Inc. www.FormsWorkFlow.com Form No. MBCA-12 (2 of 2) Rev. 10/19/2016 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