Filing Fee $5.00 NONPROFIT CORPORATION STATE OF MAINE APPLICATION FOR RESERVATION OF NAME _____________________ Deputy Secretary of State A True Copy When Attested By Signature _____________________ Deputy Secretary of State Pursuant to 13-B MRSA §302-A.1, the undersigned applicant executes and delivers the following Application for Reservation of Name: _____________________________________________________________________________________________________________ (Name to be reserved) Name of applicant _____________________________________________________________________________________________ Address of applicant ____________________________________________________________________________________________ DATED __________________________ ___________________________________________________ (type or print name and capacity) APPLICANT ___________________________________________________ (signature of applicant) · · · Names are reserved for a period of 120 days and may not be renewed. The Secretary of State will not act as an agent by holding applications for filing upon expiration of an existing reservation. Timely filing is the responsibility of the applicant. This application serves only as a reservation of the right to the use of a name. Actual use of the name is not recommended until the purpose for which the name is reserved is completed. 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. MNPCA-1 Rev. 11-1-2008 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