Fill and Sign the Authority to Do Business Form

_____________________ Deputy Secretary of State A True Copy When Attested By Signature _____________________ Deputy Secretary of State Filing Fee $250.00 Pursuant to 13 -C MRSA §1503 , the undersigned corporation executes and delivers the following Applica tion for Authority to do Business: FIRST : If the legal corporate name does not meet the requirements pursuant to §401 and/or 13 MRSA Chapter 22 -A §736 (if a professional corporation) a fictiti ous name under which it proposes to apply for authority to do business in the State of Maine is : (If not applicable, so indicate.) If using a fictitious name, f orm MBCA-5 must be included. ____________________________________________________________________________________________ A fictitious name is a name adopted by a foreign corporation authorized to transact business in this State because its real name is unavailable pursuant to §401 . SECOND: 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) THIRD : P ursuant to 5 MRSA §108.3 , the new commercial registered agent listed above has consented to serve as the regis tered agent for this corporation. FOUR TH: (For professional corporations only) All of the professional corporation’s shareholders, not less than a majority of its directors and all of its officers other than its clerk, secretary and treasurer, if any, are licensed in one or more states to render a professional service described in its articles of incorporation. Form No . MBCA-12 (1 of 2 ) FOREIGN BUSINESS CORPORATION STATE OF MAINE APPLICATION FOR AUTHORITY TO DO BUSINESS (Check box only if applicable.) This is a professional corporation pursuant to 13 MRSA Chapter 22-A .** (see footnote) ______________________________________ (Name of Corporation in Jurisdiction of Incorporation) FIFTH: Its jurisdiction of incorporation is _________________________________ (state or country) and the date of incorporation is ______________________. SIXTH : Address of the principal office, wherever located, is: _______________________________________________________________________________________________ (street, city, state and zip code) _______________________________________________________________________________________________ (mailing address if different from above) SEVENTH : The nam es and usual business addresses of its current directors and officers: (Attach additional pages, if necessary.) _____________________________________________ _ Street ___________________________________________ (type or print name and capa city) (street or mailing address) ___________________________________________ (city, state and zip code) ______________________________________________ Street ____________________________ _______________ (type or print name and capacity) (street or mailing address) __________________________________________ (city, state and zip code) _____________________________________ _________ Street ___________________________________________ (type or print name and capacity) (street or mailing address) __________________________________________ (city, state and zip c ode) EIGHTH: This application must be 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 record s in the state or country under whose law the foreign corporation is incorporated. The certificate of existence mu st have been made not more than 90 days prior to the delivery of this application for filing. Dated __________________________ *By _____________ ______________________________________ (original signature of an officer) _ __________________________________________________ (type or print name and capacity /title) **The professional corpor ation name as used in the State of Maine must contain one of the following: “chartered,” “professional corporation,” “professional association” or “service corporation” or the abb reviation “P.C.,” “P.A.” or “S.C.”. If the legal name in your jurisdiction doesn’t require the use of these words, you must file a fictitious name. (Se e item first) *This document MUST be originally signed by any duly authorized officer. ( 13-C MRSA §121.5 ) 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 . MBCA-12 (2 of 2 ) Rev. 10/19/2016 Filer Contact Cover Letter To: Department of the Secretary of State Tel. (207) 624-7752 Division of Corporatio ns, UCC and Commissions 101 State House Station Augusta, ME 04333-0101 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 se rvice ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 a dditional filing fee per entity, per service) Total filing fee(s) enclosed: $ ________________ Contact Information – questions regarding th e 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 St ate’s office) ___________________________________ ___________________________________ (Name of contact person) (Daytime telephone number) ____________________________________________________ (Email address) The enclosed filing(s) and fee(s) are submitted for f iling. Please return the attested copy to the following address: ______________________________________________________________________________ (Name of attested recipient) _____________________________________________________________________________________________ (Firm or Company) _____________________________________________________________________________________________ (Mailing Address) _____________________________________________________________________________________________ (City, State & Zip) _____________________ Deputy Secretary of State A True Copy When Attested By Signature _____________________ Deputy Secretary of State Filing Fee $250.00 FOREIGN LIMITED LIABILITY COMPANY STATE OF MAINE STATEMENT OF FOREIGN QUALIFICATION TO CONDUCT ACTIVITIES ______________________________________ (Name of Limited Liability Company in Jurisdiction of Organization) Pursuant to 31 MRSA §1622 , the undersigned limited liability company executes and delivers the following Statem ent of Foreign Qualification: FIRST: If the name of the limited liability company in the jurisdiction of organization does not contain one of the word s or abbreviations required by 31 MRSA § 1508.1 (“limited liability company” or “limited company” or the abbreviation “L.L.C.,” “LLC,” “L.C.” o r “LC” or, in the case of a low-profit limited liability company, “L3C” or “l3c”), the proposed name to be used in this State in compliance with this requirement is: * (If not applicable, so indicate.) _______________________________________________________________________________________________ SECOND: If the name of the limited liability company in the jurisdiction of organization is unavailable pursuant to 31 MRSA §1508 , the fictitio us name under which it seeks authority to conduct activities in the State of Maine is: (If not applicable, so indicate.) ______________________________________________________________________________________________ Form MLLC-5 accompanies this application. (See 31 MRSA § 1624.1 ) THIRD: Date of formation: ________________________ Jurisdiction where formed: _______________________________ Address of the principa l office, wherever located: _________________________________________________________________________________________ (physical location - street (not P.O. Box), city, state and zip code) _________________________________________________________________________________________ (m ailing address if different from above) FOURTH: The foreign limited liability company is a foreign limited liability company as defined in 31 MRSA §1502.11. FIFTH: The nature of the business or purpose(s) to be conducted or promoted in the State of Maine is: __________________________________________________________________________________________. Form No. MLLC-12 (1 of 3) 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 §105.2 , the registered agent listed above has consented to serve as the registered agent for this lim ited liability company. EIGHTH: The name and business, residence and mailing address of each manager (if any): NAME ADDRESS ____________________________________ ___________________________________________________ ____________________________________ ___________________________________________________ ____________________________________ ___________________________________________________ Names and addresses of additional managers are a ttached as Exhibit ____, and made a part hereof. NINTH: The date on which the foreign limited liability company co mmenced or expects to commence conducting activities in the State of Maine is _______________________________. TENTH: Check only if applicable This is a professional limited liability company qualified pursuant to 13 MRSA Chapter 22-A to provide the following professional services (see 13 MRSA, chapter 22-A for information on what constitutes professi onal services): ____________________________________________________________________________________________ (type of professional services) Form No. MLLC-12 (2 of 3) ELEVENTH: (Check if applicable) The foreign limited liability company is governed by an agreement that establishes or provides for the establishment of designated series having separate right s, powers or duties with respect to specified property or obligations of the foreign limited liability company or profits and losses associated with specified property or obligations. Additional information required pursuant to MRSA 31 §1622.2.J are attached hereto as Exhi bit _________, and made a part hereof. TWELFTH: This statement of qualification is accompan ied by a certificate of existence or such other document that the Secretary of State determines to be suitable for purposes of proving the valid existence of the foreign limited liability company under the law of the State or other jurisdiction listed in item Third. The certificate or other document must not have been issued more than 90 days before the delivery of th is statement to the office of the Secretary of State. Dated ______________________________ ___________________________________________________ (Authorized Signature**) ___________________________________________________ (Type or print name and capacity) * Th e limited liability company name as used in the State of Maine must contain one of the following: “limited liability company” or “limited company” or the abbreviation “L.L.C.,” “LLC,” “L.C.” or “LC” or, in the case of a low-profit limited liability compan y, “L3C” or “l3c” – see 31 MRSA 1508 ). If the limited liability company's name in its jurisdiction of organization complies with 31 MRSA § 1508 with the addition of these words, th en no fictitious name filing is require d pursuant to 31 MRSA §§ 1622.2.A and 1624.1. ** Statement MUST be signed by at least one authorized person ( 31 MRSA §1676.1B ). The execution of this statem ent cons titutes an oath or affirmation under the penalties of false swearing under 17-A MRSA §453 . Pl ease remit your payment made payabl e to the Maine Secretary of State. Submit completed form to: Secretary of State Division of Corp orations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101 Telephone Inquiries: (207) 624-7752 Email Inquiries: CEC.Corporations@Maine.gov Form No. MLLC-12 (3 of 3) 7/1/2011 Filer Contact Cover Letter To: Department of the Secretary of State Tel. (207) 624-7752 Division of Corporatio ns, UCC and Commissions 101 State House Station Augusta, ME 04333-0101 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 se rvice ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 a dditional filing fee per entity, per service) Total filing fee(s) enclosed: $ ________________ Contact Information – questions regarding th e 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 St ate’s office) ___________________________________ ___________________________________ (Name of contact person) (Daytime telephone number) ____________________________________________________ (Email address) The enclosed filing(s) and fee(s) are submitted for f iling. Please return the attested copy to the following address: ______________________________________________________________________________ (Name of attested recipient) _____________________________________________________________________________________________ (Firm or Company) _____________________________________________________________________________________________ (Mailing Address) _____________________________________________________________________________________________ (City, State & Zip)