Amended Annual Report {MBCA-13A}

Filing Fee $85.00 for domestic; $150.00 for foreign BUSINESS CORPORATION STATE OF MAINE AMENDED ANNUAL REPORT _______________________ Deputy Secretary of State ____________________________________________ A True Copy When Attested By Signature ______________________________________ (Name of Corporation) _______________________ Deputy Secretary of State Pursuant to 13-C MRSA §1623, the undersigned corporation executes and delivers the following Amended Annual Report: FIRST: SECOND: THIRD: The jurisdiction of its incorporation is _________________________________________________________________. The original annual report was filed on (date) ___________________________________. The information has changed as follows (attach additional pages, if necessary): _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ FOURTH: This information changed on (date) _______________________________. *By ___________________________________________________ (authorized signature) DATED _________________________ ___________________________________________________ (type or print name and capacity) An amended annual report may be filed by the corporation to change information currently on file. The time for filing an amended annual report is from the date of the original filing until December 31st of that filing year. If you are changing the officer, director or shareholder information, you must provide the name, title and complete physical address of this individual. Additionally, you must provide the information currently on file and indicate how it changed. *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 REPORTING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 TEL. (207) 624-7752 Form No. MBCA-13A (1 of 1) Rev. 10/25/2012 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