DOMESTIC
NONPROFIT CORPORATION
STATE OF MAINE
ST A TEMENT OF INTENT TO DISSOL VE
(Written Consent of Members or Directors)
(Name of Corporation)
Pursuant to 13-B MRSA §1101, the undersigned corporation executes and delivers for filing the following statement of intent to
dissolve the corporation.
FIRST:
The names and respective addresses of its officers and directors are
~
Address
President
Treasurer
Secretary
Directors :
(List additional directors on reverse side)
SECOND:
:"x" one box only)
Exhibit A attached hereto is a copy of the written consent signed by
D
All members
of the corporation
entitled
to vote.
D All directors of the corporation, there being no members or no members entitled to vote.
nnRD:
All required Reports have been fIled with the Secretary of State. (Note: If the dissolution process is completed on or
before June lst, then the Report covering the previous calendar year is not required.)
FOURm:
The undersigned corporation understands that the fIling of this document DOES NOT complete the dissolution
process. You must ALSO FILE Articles of Dissolution.
FIFm:
The address of the registered office of the corporation in the State of Maine is
(street, city, state aOO zip code)