Statement Of Appointment Or Change Noncommercial Registered Agent {MNPCA-3-NCRA}

Filing Fee $15.00 for each nonprofit corporation listed NONPROFIT CORPORATION STATE OF MAINE NONCOMMERCIAL REGISTERED AGENT STATEMENT OF APPOINTMENT or CHANGE _____________________ Deputy Secretary of State A True Copy When Attested By Signature ______________________________________ (Name of Corporation as it appears on the records of the Secretary of State) _____________________ Deputy Secretary of State Pursuant to 5 MRSA §§105, 108, & 109 the undersigned corporation executes and delivers the following statement of appointment and/or change of address by a noncommercial registered agent. FIRST: ("X" all boxes that apply) A. B. C. D. SECOND: change of address change to/of noncommercial registered agent and address change of noncommercial registered agent change in name of current noncommercial registered agent The name and address of the registered agent appearing on the record in the Secretary of State's office: _______________________________________________________________________________________________ (name of current registered agent) _______________________________________________________________________________________________ (physical street address, city, state and zip code) _______________________________________________________________________________________________ (mailing address if different from above) THIRD: (For foreign nonprofit corporations only) Jurisdiction of Organization: ________________________________________________________________ __________________________________________ Date authorized to transact business in the State of Maine: Form No. MNPCA-3-NCRA (1 of 2) American LegalNet, Inc. www.FormsWorkFlow.com FOURTH: Complete this Item as follows based on your selection in Item First: A. B. C. D. The new address of the noncommercial registered agent (provide address information only); The name and address of the new noncommercial registered agent (provide name and address information); The name of the new noncommercial registered agent (provide name only); OR The new name of the current noncommercial registered agent (provide name only). _______________________________________________________________________________________________ (name of new noncommercial registered agent or new name of current noncommercial registered agent) _______________________________________________________________________________________________ (physical street address, not a P.O. Box ­ city, state and zip code) _______________________________________________________________________________________________ (mailing address if different from above) FIFTH: Pursuant to 5 MRSA §108.3, the registered agent as listed above has consented to serve as the registered agent for this nonprofit corporation. The undersigned noncommercial registered agent of the following corporation(s) has notified each corporation of the change indicated in Item First A or D: Name of Nonprofit Corporation Jurisdiction Date incorporated or authorized in Maine SIXTH: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Names of additional corporations attached hereto as Exhibit ___, and made a part hereof. Dated _________________________ *By ____________________________________________________ (signature) ____________________________________________________ (type or print name and capacity) *This statement MUST be signed as follows: (1) if Item First, A or D was selected, then by the noncommercial registered agent OR (2) if Item First, B or C was selected, then by any duly authorized officer 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. MNPCA-3-NCRA (2 of 2) 7/1/2008 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)