Application for Authority to Carry on Activities pursuant to 13-B MRSA §1202 to accompany Application for Transfer of Authority FIRST: The name of the corporation is: ____________________________________________________________________________________________ SECOND: 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. THIRD: Its jurisdiction of incorporation is _____________________ and the date of incorporation is ____________________. FOURTH: Purpose(s) it is authorized to do under the laws of its jurisdiction of incorporation: ____________________________ ______________________________________________________________________________________________ FIFTH: 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. _____________________________ ______________________________________________________________________________________________ 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) Form No. MNPCA-12-1 (1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com 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. 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-12-1 (2 of 2) Rev. 7/1/2008 American LegalNet, Inc. www.FormsWorkFlow.com