Resigning Registered Agent*
DATED __________________________
___________________________________________________
___________________________________________________
)
(signature)
(type or print name
For a Resigning Registered Agent which is a Corporation
Name of Corporation _____________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
Note:
If this document changes the Registered Agent and the new Registered Agent does not sign this form, then
Form
MLPA-18 (31 MRSA §494.2-A
must accompany this document.
)
The undersigned hereby accepts the appointment as registered agent for the above-named limited partnership(s).
Registered Agent
DATED __________________________
___________________________________________________
___________________________________________________
)
(signature)
(type or print name
For Registered Agent which is a Corporation
Name of Corporation _____________________________________________________________________________________________
By ________________________________________________
___________________________________________________
(authorized signature)
(type or print name and capacity)
*Certificate MUST be signed by the registered agent.
The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under
17-A MRSA
§453.
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. MLPA-12D (2 of 2) Rev. 8/1/2004
TEL. (207) 624-7752