Form Center

Rental Registration Corporate Disclosure

2. CORPORATE DISCLOSURE
   Must Be Completed if Building is Not Individually Owned

   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

* indicates a required field