Filing Fee $15.00 FOREIGN NONPROFIT CORPORATION STATE OF MAINE AMENDED APPLICATION FOR AUTHORITY TO CARRY ON ACTIVITIES _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Corporation) _____________________ Deputy Secretary of State Pursuant to 13-B MRSA §1207, the undersigned foreign corporation executes and delivers the following Amended Application for Authority to Carry on Activities: FIRST: SECOND: THIRD: The jurisdiction of its incorporation is ______________________________________________________________. The date on which it was authorized to carry on activities in the State of Maine is __________________________. The proposed amendment to its application of authority is ______________________________________________ ______________________________________________________________________________________________. FOURTH: The corporate name of the corporation has been changed to (If no change, so indicate.) ________________________ __________________________________________________________________ under the laws of its jurisdiction of incorporation on ______________. (date) FIFTH: If the real corporate name is not available, the fictitious name under which it proposes to apply for authority to carry on activities in the State of Maine is (If not applicable, so indicate.) ______________________________________________________________________________________________. Form MNPCA-5 accompanies this application. A fictitious name is a name adopted by a foreign corporation authorized to carry on activities in this State because its real name is unavailable pursuant to 13-B MRSA §301-A. SIXTH: The activity (activities) which it seeks to pursue in the State of Maine is (are) authorized by the laws of its jurisdiction of incorporation and consist(s) of (If no change, so indicate.) _____________________________________________ _______________________________________________________________________________________________ ______________________________________________________________________________________________. FORM NO. MNPCA-12A (1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com SEVENTH: The new address of its registered or principal office, wherever located, is (If no change, so indicate.) ______________________________________________________________________________________________. (street, city, state and zip code) EIGHTH: The address of the registered office of the corporation in the State of Maine is _______________________________ ______________________________________________________________________________________________. (street, city, state and zip code) DATED _________________________ *By ___________________________________________________ (signature of any duly authorized individual) ___________________________________________________ (type or print name and capacity) *This document MUST be signed by any duly authorized individual. 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 TEL. (207) 624-7740 FORM NO. MNPCA-12A (2 of 2) Rev. 4/1/2009 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