Filing Fee for an Assumed Name $125.00 Filing Fee for a Fictitious Name $40.00 LIMITED LIABILITY COMPANY STATE OF MAINE STATEMENT OF INTENTION TO TRANSACT BUSINESS UNDER AN ASSUMED OR FICTITIOUS NAME (for Maine or Foreign LLC) _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Maine or Foreign Limited Liability Company) _____________________ Deputy Secretary of State Pursuant to 31 MRSA §1510, the undersigned limited liability company executes and delivers the following Statement of Intention to Transact Business Under an Assumed or Fictitious Name: FIRST: ("X" one box only.) assumed name (§1510-1.A) fictitious name (§1510-1.B) The limited liability company intends to transact business under the assumed or fictitious name of _______________________________________________________________________________________. Note: A fictitious name is a name adopted by a foreign limited liability company authorized to transact business in this State because its real name is unavailable pursuant to §1508. Complete the following if applicable: SECOND: If such assumed name is to be used at fewer than all of the limited liability company's places of business in this State, the location(s) where it will be used is (are): __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Additional locations are attached hereto as Exhibit _____, and made a part hereof. American LegalNet, Inc. www.FormsWorkFlow.com Form No. MLLC-5 (1 of 2) THIRD: (Foreign Limited Liability Company Only) Jurisdiction of organization ______________________________________________________ and the date on which the limited liability company was authorized to transact business in Maine ___________________________________. DATED __________________________ *Authorized person(s) ________________________________________________ (authorized signature) _______________________________________________ (Type or print name of authorized person) *Pursuant to 31 MRSA §1676.1B, this statement MUST be signed by a person authorized by the limited liability company. The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under 17-A MRSA §453. 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. MLLC-5 (2 of 2) 11/16/2012 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