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Statement Of Appointment Or Change (Foreign Business Corporation) Form. This is a Maine form and can be use in Business Corporation Secretary Of State.
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Tags: Statement Of Appointment Or Change (Foreign Business Corporation), MBCA-12-NCRA, Maine Secretary Of State, Business Corporation
Filing Fee $35.00 for each corporation listed
FOREIGN
BUSINESS CORPORATION
STATE OF MAINE
NONCOMMERCIAL REGISTERED AGENT
_____________________
Deputy Secretary of State
STATEMENT OF
APPOINTMENT or CHANGE
A True Copy When Attested By Signature
_____________________
Deputy Secretary of State
______________________________________
(Name of Corporation)
Pursuant to 5 MRSA §§105, 108, & 109 the undersigned corporation executes and delivers the following statement of appointment
and/or change of address by a noncommercial Registered Agent.
("X" all boxes that apply)
FIRST:
A.
change of address
B.
change of noncommercial registered agent and address
C.
change of noncommercial registered agent
D.
change in name of current noncommercial registered agent
SECOND:
The name and address of the registered agent appearing on the record in the Secretary of State's office:
_______________________________________________________________________________________________
(name of current registered agent)
_______________________________________________________________________________________________
(physical street address, city, state and zip code)
_______________________________________________________________________________________________
(mailing address if different from above)
THIRD:
(Complete the following if Item First B or C was checked above.)
Jurisdiction of incorporation:
________________________________________________________________
Date authorized to transact business in the State of Maine:
Form No. MBCA-12D-NCRA (1 of 2)
__________________________________________
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FOURTH:
Complete this Item as follows based on your selection in Item First:
A.
B.
C.
D.
The new address of the noncommercial registered agent (provide address information only);
The name and address of the new noncommercial registered agent (provide name and address information);
The name of the new noncommercial registered agent, (provide name only); OR
The new name of the current noncommercial registered agent (provide name only).
_______________________________________________________________________________________________
(name of new noncommercial registered agent or new name of current noncommercial registered agent)
_______________________________________________________________________________________________
(physical street address, not a P.O. Box – city, state and zip code)
_______________________________________________________________________________________________
(mailing address if different from above)
FIFTH:
Pursuant to 5 MRSA §108.3, the registered agent as listed above has consented to serve as the registered agent for this
corporation.
SIXTH:
The undersigned noncommercial registered agent of the following corporation(s) has notified each corporation of the
change indicated in Item Fourth A or D:
Name of Corporation
Jurisdiction
Date authorized to transact business in Maine
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Names of additional corporations attached hereto as Exhibit ___, and made a part hereof.
DATED _________________________
*By ____________________________________________________
(signature)
____________________________________________________
(type or print name and capacity)
*This statement MUST be signed as follows:
(1) if Item First, A. was selected, then by the noncommercial registered agent OR
(2) if Item First, B. was selected, then by any duly authorized officer OR
(3) if Item First, C. was selected, then by any duly authorized officer OR
(4) if Item First, D. was selected, then by the noncommercial registered agent.
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
Form No. MBCA-12D-NCRA (2 of 2) 7/1/2008
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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)
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