Termination Of Statement Of Intention To Do Business Under Assumed Or Fictitious Name {MBCA-5A}

Deputy Secretary of State A True Copy When Attested By Signature Deputy Secretary of State Filing Fee $20.00 BUSINESS CORPORATION STATE OF MAINE TERMINATION OF STATEMENT OF INTENTION TO DO BUSINESS UNDER AN ASSUMED OR FICTITIOUS NAME (Real Name of Corporation) Pursuant to 13-C MRSA 247404.8, the undersigned corporation executes and delivers the following Termination of Statement of Intention to do Business Under an Assumed or Fictitious Name: FIRST: The corporation no longer intends to transact business under an assumed or fictitious name. SECOND: The corporation intends to terminate the assumed or fictitious name of . DATED *By (signature of any duly authorized person) (type or print name and capacity) *This document MUST be signed by any duly authorized officer OR the clerk. (247121.5) 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. MBCA-5A 7/1/2003 TEL. (207) 624-7740 American LegalNet, Inc. www.FormsWorkFlow.com Filer Contact Cover Letter To: Department of the Secretary of State Tel. (207) 624-7752 Division of Corporations, UCC and Commissions 101 State House Station Augusta, ME 04333-0101 Name of Entity (s): List type of filing(s) enclosed (i.e. Articles of Incorporation, Articles of Merger, Articles of Amendment, Certificate of Correction, etc.) Attach additional pages as needed. Special handling request(s): (check all that apply) Hold for pick up Expedited filing - 24 hour service ($50 additional filing fee per entity, per service) Expedited filing - Immediate service ($100 additional filing fee per entity, per service) Total filing fee(s) enclosed: $ Contact Information 226 questions regarding the above filing(s), please call or email: (failure to provide a contact name and telephone number or email address will result in the return of the erroneous filing (s) by the Secretary of State222s office) (Name of contact person) (Daytime telephone number) (Email address) The enclosed filing(s) and fee(s) are submitted for filing. Please return the attested copy to the following address: (Name of attested recipient) (Firm or Company) (Mailing Address) (City, State & Zip) American LegalNet, Inc. www.FormsWorkFlow.com