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Fill and Sign the Pursuant to 13 C Mrsa 402 Form

Fill and Sign the Pursuant to 13 C Mrsa 402 Form

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_____________________ Deputy Secretary of S tate A Tr ue Copy Whe n Atte ste d By Signatur e _____________________ Deputy Secretary of S tate Filing Fee $20.00 BUSINESS CORPORATION STATE OF MAINE APPLICATION FOR RESERVATION OF NAME Pursuant to 13-C M RSA §402.1 , the undersi gned appl icant execut es and del ivers t he fol lowi ng Appl icat ion for R eservat ion of Nam e: ________________________________________________________________________\ _____________________________________ (Nam e to be reserv ed) Nam e of appl icant ______________________________________________________________________\ ________________________ Address of appl icant _______________________________________________________________________\ _____________________ APPLICANT DATED __________________________ __________________________________________________ ______________________________________________________ (signatur e of applicant) (type or print name and capacity) • Nam es are reserved for a peri od of 120 day s and may not be renewed . • Th e Secretary o f State will not act as an agent by hol ding appl icat ions for filing upon expi rat ion of an exi sting reservat ion. Ti mely filing is the responsibility of the applicant. • Thi s appl icat ion serves onl y as a reservat ion of t he ri ght to the use of a nam e. Act ual use of the nam e is not recommended until th e purpose fo r wh ich the n ame is reserv ed is co mpleted . Please rem it your pay ment made pay able to the Maine Secretary of State. SUBMIT COMPLETED FORMS TO: CORPORATE EX AMINING SECTION, SECRETARY OF STATE, 101 ST AT E HOUSE ST AT ION, AUGUST A, ME 04333-0101 FOR M NO. MBCA-1 7/1/2003 TEL. (207) 624-77 52 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)

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