Application For Excuse {MNPCA-14}

Deputy Secretary of State A True Copy When Attested By Signature Deputy Secretary of State DOMESTIC NONPROFIT CORPORATION STATE OF MAINE APPLICATION FOR EXCUSE Filing Fee $5.00 (Name of Corporation) Pursuant to 13-B MRSA 2471301.5, the undersigned corporation executes and delivers for filing this Application for Excuse: President Treasurer I, Clerk or Secretary (circle title) of the above named corporation, a corporation duly organized under the laws of the State of Maine, certify that said corporation ceased to carry on activities on (date) . Application is made to be excused from further filing an annual report with the Secretary of State of Maine, so long as the corporation in fact carries on no activities. I further certify that all required Annual Reports have been filed with the Secretary of State. (Note: If the excuse process is completed on or before June 1st, then the Annual Report covering the previous calendar year is not required.) DATED (signature) NOTE: The excuse is effective upon acceptance by the Office of the Secretary of State. SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MNPCA-14 Rev. 4/16/2001 TEL. (207) 624-7752 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