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 §108.3, the registered agent as listed above has consented to serve as the
registered agent for this nonprofit corporation.
EIGHTH: This application is 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 records in the state or country under whose law the
foreign corporation is incorporated. The certificate of existence must have been made not more than 90 days prior to
the delivery of this application for filing.
Dated _________________________ *By ___________________________________________________
(signature of any duly authorized individual)
___________________________________________________
(type or print name and capacity)
*This document MUST be signed by any duly authorized individual.
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-12 (2 of 2) Rev. 7/1/2008