Filing Fee for an Assumed Name $125.00 Filing Fee for a Fictitious Name $40.00 LIMITED LIABILITY PARTNERSHIP STATE OF MAINE STATEMENT OF INTENTION TO DO BUSINESS UNDER AN ASSUMED OR FICTITIOUS NAME _____________________ Deputy Secretary of State A True Copy When Attested By Signature _____________________ Deputy Secretary of State ______________________________________ (Real Name of Limited Liability Partnership) Pursuant to 31 MRSA §805-A, the undersigned limited liability partnership executes and delivers the following Statement of Intention to do Business Under an Assumed or Fictitious Name: FIRST: ("X" one box only.) assumed name (31 MRSA §805-A.1) fictitious name (31 MRSA §805-A.2) The limited liability partnership intends to transact business under the assumed or fictitious name of _____________________________________________________________________________________________. Please note: A fictitious name is a name adopted by a foreign limited liability partnership authorized to transact business in this State because its real name is unavailable pursuant to 31 MRSA §803-A. Complete the following if applicable: SECOND: If such assumed name is to be used at fewer than all of the limited liability partnership'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. THIRD: (Foreign Limited Liability Partnership Only) Jurisdiction of organization ______________________________________________________ and the date on which the limited liability partnership was authorized to transact business in Maine _________________________________ FORM NO. MLLP-5 (1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com DATED __________________________ Partner(s)* ___________________________________________________ (signature) __________________________________________________ (type or print name and capacity) For Partner(s) which are Entities Name of Entity _________________________________________________________________________________________________ By _______________________________________________ (authorized signature) ___________________________________________________ (type or print name and capacity) *Certificate MUST be signed by (1) at least one partner OR (2) any duly authorized person. 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 FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MLLP-5 (2 of 2) Rev. 8/1/2004 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