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Form Mnpca-5 - Statement Of Intention To Carry On Activities Under An Assumed Or Fictitious Name For A Nonprofit Corporation - 2004

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NONPROFIT CORPORATION

STATE OF MAINE

STATEMENT OF INTENTION

_____________________

TO CARRY ON ACTIVITIES UNDER

Deputy Secretary of State

AN ASSUMED OR FICTITIOUS NAME

A True Copy When Attested By Signature

_____________________

______________________________________

Deputy Secretary of State

(Real Name of Corporation)

Pursuant to

13-B MRSA

§308-A, the undersigned corporation executes and delivers the following Statement of Intention to Carry on

Activities Under an Assumed or Fictitious Name:

FIRST:

The address of the registered office of the corporation in the State of Maine is _______________________________

_______________________________________________________________________________________________.

(street, city, state and zip code)

SECOND:

("X" one box only.)

assumed name

(13-B MRSA

§308-A.1)

fictitious name

(13-B MRSA

§308-A.2)

The corporation intends to carry on activities under the assumed or fictitious name of

_______________________________________________________________________________________________.

Please note: 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.

Complete the following if applicable:

THIRD:

If such assumed name is to be used at fewer than all of the corporation's places of activity in this State, the location(s)

where it will be used is (are):

________________________________________________________________________________________________

FORM NO. MNPCA-5 (1 of 2)

Form Mnpca-5 - Statement Of Intention To Carry On Activities Under An Assumed Or Fictitious Name For A Nonprofit Corporation - 2004

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