Form Center

2. CORPORATE DISCLOSURE
   Must Be Completed if Building is Not Individually Owned
4. The answers to questions 1-4 must match the information on file with the Maine Secretary of State's office. Your certification must be in good standing. If you have questions regarding this information, please call the Secretary of State's Office at (207) 624-7752. Please clearly complete this information in its entirety.
6. STOCK OWNERSHIP IN NON-PUBLICLY TRADED COMPANIES MUST ADD UP TO 100%. THANK YOU.
8. 1) Exact Legal Name
10. 2) Doing Business As, If Any
12. 3) Date of Filing With the State
14. 4) State in Which Formed
16. 5) List the Names, Addresses, Titles of Officers and Directors, and List %
18. NAME - FIRST PERSON LISTED
20. Title
22. Current Address
24. Ownership %
26. NAME - SECOND PERSON LISTED
28. Title
30. Current Address
32. Ownership %
34. NAME - THIRD PERSON LISTED
36. Title
38. Current Address
40. Ownership %
42. NAME - FOURTH PERSON LISTED
44. Title
46. Current Address
48. Ownership %
50. NAME - FIFTH PERSON LISTED
52. Title
54. Current Address
56. Ownership %
58. NAME - SIXTH PERSON LISTED
60. Title
62. Current Address
64. Ownership %
66. NAME - SEVENTH PERSON LISTED
68. Title
70. Current Address
72. Ownership %
74. NAME - EIGHTH PERSON LISTED
76. Title
78. Current Address
80. Ownership %
82. SIGNATURE OF OWNER OR CORPORATE OFFICER CERTIFYING ACCURACY OF APPLICATION
83. Date
85. PRINTED NAME OF OWNER OR CORPORATE OFFICER
86. Date
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit

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