_____________________
Deputy Secretary of State
A True Copy When Attested By Signature
_____________________
Deputy Secretary of State
Filing Fee $45.00
FOREIGN
NONPROFIT CORPORATION
STATE OF MAINE
APPLICATION FOR
AUTHORITY TO CARRY ON ACTIVITIES
________________________________________
(Name of Corporation in Jurisdiction of Incorporation)
Pursuant to
13-B MRSA §1202, the undersigned corporation executes and delivers the following Application for Authority to Carry on
Activities:
FIRST: If the real corporate name is not available, the fictitious name under which it proposes to apply for authority to carry on
activities in the State of Maine is: (If not applicable, so indicate.)
_______________________________________________________________________________________________
Form MNPCA-5 accompanies this application.
A fictitious name is a name adopted by a foreign corporation authorized to carry on activities in this State because
its real name is unavailable pursuant to
13-B MRSA §301-A.
SECOND: Its jurisdiction of incorporation is _____________________ and the date of incorporation is ___________________.
THIRD: Purpose(s) it is authorized to do under the laws of its jurisdiction of incorporation:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
FOURTH: Does it seek authority to engage in all activities authorized in its jurisdiction and allowed by Maine Law?
Yes No If no, specify activity (activities) for which authority is sought. __________________________
_______________________________________________________________________________________________
FIFTH: Address of the registered or principal office, wherever located, is _________________________________________
______________________________________________________________________________________________.
(street, city, state and zip code)
Form No. MNPCA-12 (1 of 2)
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
Filer Contact Cover Letter
To: Department of the Secretary of State Tel. (207) 624-7752
Division of Corporations, 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 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)