Filing Fee $15.00 for each corporation listed NONPROFIT CORPORATION STATE OF MAINE CHANGE OF REGISTERED AGENT and/or REGISTERED OFFICE _____________________ Deputy Secretary of State A True Copy When Attested By Signature _____________________ Deputy Secretary of State ______________________________________ (Name of Corporation) Pursuant to 13-B MRSA §305.1 or 13-B MRSA §1212.2, the undersigned corporation executes and delivers for filing the following Change of Registered Agent and/or Registered Office as authorized by a resolution duly adopted by the board of directors: FIRST: ("X" all boxes that apply) A. change of registered office B. change of registered agent and registered office C. change of registered agent D. change in name of current registered agent SECOND: The name and registered office of the registered agent appearing on the record in the Secretary of State's office: _______________________________________________________________________________________________ (name of current registered agent) _______________________________________________________________________________________________ (street, city, state and zip code) THIRD: Complete this Item as follows based on your selection in Item First: A. B. C. D. The address of the new registered office (provide address information only); The name and registered office of the new registered agent, who must be an individual Maine resident or a corporation, foreign or domestic, authorized to do business or carry on activities in Maine (provide name and address information); The name of the new registered agent, who must be an individual Maine resident or a corporation, foreign or domestic, authorized to do business or carry on activities in Maine (provide name only); OR The new name of the current registered agent (provide name only). _______________________________________________________________________________________________ (name of new registered agent or new name of current registered agent) _______________________________________________________________________________________________ (physical location, not P.O. Box – street, city, state and zip code) _______________________________________________________________________________________________ (mailing address if different from above) FORM NO. MNPCA-3 (1 of 3) American LegalNet, Inc. www.FormsWorkflow.com FOURTH: (To be completed by a foreign corporation.) A. Jurisdiction of incorporation _____________________________________________________________ B. Date of authorization to carry on activities in this State _________________________________________ FIFTH: The undersigned registered agent of the following nonprofit corporation(s), who has changed the address of the registered office OR who has changed his or her name, has notified each nonprofit corporation of the change indicated in Item Third A or D: Name of Nonprofit Corporation _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Names of additional limited attached hereto as Exhibit ___, and made a part hereof. Note: The following must be signed by the proper person as designated below.* DATED _________________________ *By ____________________________________________________ (signature) ____________________________________________________ (type or print name and capacity) *By ____________________________________________________ (signature) ____________________________________________________ (type or print name and capacity) FORM NO. MNPCA-3 (2 of 3) American LegalNet, Inc. www.FormsWorkflow.com Acceptance of Appointment of New Registered Agent The undersigned hereby accepts the appointment as registered agent for the above-named nonprofit corporation. ___________________________________________________ (signature) ___________________________________________________ (type or print name) For Registered Agent which is a Corporation Name of Corporation ____________________________________________________________________________________________ By ________________________________________________ (authorized signature) Note: __________________________________________________ (type or print name and capacity) If this document changes the Registered Agent and the new Registered Agent does not sign, Form MNPCA18 (13-B MRSA §304.3 or 13-B MRSA §1212.1-A) must accompany this document. *This document MUST be signed as follows: (1) if Item First, A. was selected, then by the Registered Agent OR (2) if Item First, B or C was selected, then by any duly authorized officer OR (13-B MRSA §104.1) (3) if Item First, D. was selected, then by the Registered Agent. 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-3 (3 of 3) Rev. 9/16/2005 TEL. (207) 624-7740 American LegalNet, Inc. www.FormsWorkflow.com