Filing Fee $15.00 NONPROFIT CORPORATION STATE OF MAINE COMMERCIAL REGISTERED AGENT STATEMENT OF APPOINTMENT or CHANGE _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Corporation as it appears on the records of the Secretary of State) _____________________ Deputy Secretary of State Pursuant to 5 MRSA §§105 & 108 the undersigned nonprofit corporation executes and delivers the following statement of appointment or change of a commercial registered agent. FIRST: The name and address of the current 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) SECOND: The new CRA Public number is: __________________________ The name of the new CRA is: _______________________________________________________ THIRD: Pursuant to 5 MRSA §108.3, the registered agent listed above has consented to serve as the registered agent for this corporation. (To be completed by foreign nonprofit corporations) Jurisdiction of incorporation: ________________________________________________________________ __________________________________________ FOURTH: Date authorized to carry on activities in the State of Maine: Dated _________________________ *By _______________________________________________ (signature) _______________________________________________ (type or print name and capacity) *This statement MUST be signed by any duly authorized officer. (13-B MRSA §104.1) 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. MNPCA-3-CRA 7/1/2008 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