Form No. Mlpa-12b - Cancellation Of Authority To Do Business - Maine Secretary Of State Page 2

DATED __________________________

GENERAL PARTNER(S)*

___________________________________________________

____________________________________________________

)

(signature)

(type or print name

For General Partner(s) which are Entities

Name of Entity __________________________________________________________________________________________________

By ________________________________________________

____________________________________________________

(authorized signature)

(type or print name and capacity)

*Certificate MUST be signed by

(1) at least one general partner OR

(2) any duly authorized person.

The execution of this certificate constitutes an oath or affirmation under the penalties of false swearing under Title 17-A, section 453.

SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,

101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101

FORM NO. MLPA-12B

Rev. 4/16/2001

TEL. (207) 624-7740

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