Certificate Of Excuse {MBCA-14}

Filing Fee $40.00 DOMESTIC BUSINESS CORPORATION STATE OF MAINE CERTIFICATE OF EXCUSE _____________________ Deputy Secretary of State A True Copy When Attested By Signature _____________________ Deputy Secretary of State ______________________________________ (Name of Corporation) Pursuant to 13-C MRSA §1621.4, the undersigned corporation executes and delivers the following Certificate of Excuse: FIRST: SECOND: The corporation has ceased to transact business. The corporation is not indebted to this State for failure to file an annual report and to pay any fees or penalties accrued. If the excuse process is completed on or before June 1st, then the Annual Report covering the previous calendar year is not required. The effective date of the certificate of excuse (if other than the date of filing of the certificate of excuse): _______________________________. THIRD: DATED _________________________ *By __________________________________________________ (signature of any duly authorized person) __________________________________________________ (type or print name and capacity) *This document MUST be signed by any duly authorized officer OR the clerk. (13-C MRSA §121.5) 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 FORM NO. MBCA-14 (1 of 1) Rev. 8/1/2004 TEL. (207) 624-7752 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