Filing Fee $70.00 FOREIGN BUSINESS CORPORATION STATE OF MAINE APPLICATION FOR TRANSFER OF AUTHORITY _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ _____________________ Deputy Secretary of State (Name of Corporation) Pursuant to 13-C MRSA §1524, the undersigned foreign corporation executes and delivers the following Application for Transfer of Authority: FIRST: The current jurisdiction of its incorporation is _________________________________________________________ and the date on which it was authorized to transact business in the State of Maine is __________________________. SECOND: The type of entity to which it has been converted: ("X" one box only.) Foreign Nonprofit Corporation Foreign Limited Partnership Foreign Limited Liability Company Foreign Limited Liability Partnership THIRD: The new jurisdiction whose laws govern its internal affairs is _____________________________________________. FOURTH: All the statements required to be set forth in an Application for Authority are attached as Exhibit _____________. For a Foreign Nonprofit Corporation, attach form MNPCA-12-1. For a Foreign Limited Partnership, attach form MLPA-12-1. For a Foreign Limited Liability Company, attach form MLLC-12-1. For a Foreign Limited Liability Partnership, attach form MLLP-12-1. 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. (§1524.1) 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-12C 7-1-2003 TEL. (207) 624-7752 American LegalNet, Inc. www.FormsWorkFlow.com