Form MBCA-5 "Statement of Intention to Do Business Under an Assumed or Fictitious Name" - Maine

What Is Form MBCA-5?

This is a legal form that was released by the Maine Department of the Secretary of State - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2004;
  • The latest edition provided by the Maine Department of the Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MBCA-5 by clicking the link below or browse more documents and templates provided by the Maine Department of the Secretary of State.

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Download Form MBCA-5 "Statement of Intention to Do Business Under an Assumed or Fictitious Name" - Maine

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Filing Fee for an Assumed Name $125.00
Filing Fee for a Fictitious Name $40.00
BUSINESS CORPORATION
STATE OF MAINE
STATEMENT OF INTENTION
_____________________
TO DO BUSINESS UNDER
Deputy Secretary of State
AN ASSUMED OR FICTITIOUS NAME
A True Copy When Attested By Signature
_____________________
______________________________________
Deputy Secretary of State
(Real Name of Corporation)
Pursuant to
13-C MRSA
§404, the undersigned corporation executes and delivers the following Statement of Intention to do Business
Under an Assumed or Fictitious Name:
FIRST:
("X" one box only.)
assumed name
(13-C MRSA
§404.1)
fictitious name
(13-C MRSA
§404.2)
The corporation intends to transact business under the assumed or fictitious name of
______________________________________________________________________________________________.
Please note: A fictitious name is a name adopted by a foreign corporation authorized to transact business in this
State because its real name is unavailable pursuant to
13-C MRSA
§401.
Complete the following if applicable:
SECOND:
If the assumed name is to be used at fewer than all of the corporation's places of business in this State, the location(s)
where it will be used is (are):
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
THIRD:
(Foreign Corporation Only)
Jurisdiction of incorporation ______________________________________________________ and the date on which
the corporation was authorized to transact business in Maine ______________________________________________.
FORM NO. MBCA-5 (1 of 2)
Filing Fee for an Assumed Name $125.00
Filing Fee for a Fictitious Name $40.00
BUSINESS CORPORATION
STATE OF MAINE
STATEMENT OF INTENTION
_____________________
TO DO BUSINESS UNDER
Deputy Secretary of State
AN ASSUMED OR FICTITIOUS NAME
A True Copy When Attested By Signature
_____________________
______________________________________
Deputy Secretary of State
(Real Name of Corporation)
Pursuant to
13-C MRSA
§404, the undersigned corporation executes and delivers the following Statement of Intention to do Business
Under an Assumed or Fictitious Name:
FIRST:
("X" one box only.)
assumed name
(13-C MRSA
§404.1)
fictitious name
(13-C MRSA
§404.2)
The corporation intends to transact business under the assumed or fictitious name of
______________________________________________________________________________________________.
Please note: A fictitious name is a name adopted by a foreign corporation authorized to transact business in this
State because its real name is unavailable pursuant to
13-C MRSA
§401.
Complete the following if applicable:
SECOND:
If the assumed name is to be used at fewer than all of the corporation's places of business in this State, the location(s)
where it will be used is (are):
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
THIRD:
(Foreign Corporation Only)
Jurisdiction of incorporation ______________________________________________________ and the date on which
the corporation was authorized to transact business in Maine ______________________________________________.
FORM NO. MBCA-5 (1 of 2)
DATED _________________________
*By___________________________________________________
(signature of any duly authorized officer)
___________________________________________________
(type or print name and capacity)
*This document MUST be signed by any duly authorized officer OR the clerk.
(13-C MRSA
§121.5)
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-5 (2 of 2) Rev. 8/1/2004
TEL. (207) 624-7752
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 – 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 State’s 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)
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