Form Mnpca-19 - Foreign Nonprofit Corporation Articles Of Domestication And Conversion - 2003

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FOREIGN

NONPROFIT CORPORATION

STATE OF MAINE

ARTICLES OF DOMESTICATION AND

_____________________

CONVERSION

Deputy Secretary of State

A True Copy When Attested By Signature

______________________________________

_____________________

(Name of Corporation in Jurisdiction of Incorporation)

Deputy Secretary of State

Pursuant to

13-C MRSA

§942, the undersigned corporation executes and delivers the following Articles of Domestication and

Conversion:

FIRST:

If the real corporate name is not available or the corporation desires to change its name in connection with the

domestication and conversion, the name it proposes to use in the State of Maine:

______________________________________________________________________________________________.

The corporation was originally incorporated in __________________________________________ (state or country)

and the original date of incorporation was ____________________________.

The domestication and conversion of the corporation in this State was duly authorized as required by the laws of the

SECOND:

jurisdiction in which the corporation was incorporated.

THIRD:

All the statements required to be set forth in Articles of Incorporation (Form MBCA-6-1) are attached as Exhibit

________.

FOURTH:

The effective date of the articles of domestication and conversion (if other than the date of filing of the articles of

domestication and conversion) is _______________________________.

DATED _________________________

*By ___________________________________________________

(signature of an officer or other duly authorized representative)

__________________________________________________

(type or print name and capacity)

*This document MUST be signed by an officer or other duly authorized representative. (§942.1)

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. MNPCA-19 7-1-2003

TEL. (207) 624-7752

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