Filing Fee $45.00 FOREIGN NONPROFIT CORPORATION STATE OF MAINE APPLICATION FOR AUTHORITY TO CARRY ON ACTIVITIES _____________________ Deputy Secretary of State A True Copy When Attested By Signature ________________________________________ _____________________ Deputy Secretary of State (Name of Corporation in Jurisdiction of Incorporation) Pursuant to 13-B MRSA §1202, the undersigned corporation executes and delivers the following Application for Authority to Carry on Activities: FIRST: 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. SECOND: Its jurisdiction of incorporation is _____________________ and the date of incorporation is ___________________. THIRD: Purpose(s) it is authorized to do under the laws of its jurisdiction of incorporation: _______________________________________________________________________________________________ _______________________________________________________________________________________________ FOURTH: Does it seek authority to engage in all activities authorized in its jurisdiction and allowed by Maine Law? Yes No If no, specify activity (activities) for which authority is sought. __________________________ _______________________________________________________________________________________________ FIFTH: Address of the registered or principal office, wherever located, is _________________________________________ ______________________________________________________________________________________________. (street, city, state and zip code) Form No. MNPCA-12 (1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com SIXTH: The Registered Agent is a: (select either a Commercial or Noncommercial Registered Agent) Commercial Registered Agent CRA Public Number: ____________________ __________________________________________________________________________________ (name of commercial registered agent) Noncommercial Registered Agent __________________________________________________________________________________ (name of noncommercial registered agent) __________________________________________________________________________________ (physical location, not P.O. Box – street, city, state and zip code) __________________________________________________________________________________ (mailing address if different from above) SEVENTH: Pursuant to 5 MRSA §108.3, the registered agent as listed above has consented to serve as the registered agent for this nonprofit corporation. EIGHTH: This application is accompanied by a certificate of existence or a document of similar import duly authenticated by the Secretary of State or other official having custody of corporate records in the state or country under whose law the foreign corporation is incorporated. The certificate of existence must have been made not more than 90 days prior to the delivery of this application for filing. 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 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-12 (2 of 2) Rev. 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