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STATE OF MONTANA

This is the minimum information required.

)

(This space for use by the Secretary of State only

REGISTRATION of

ASSUMED BUSINESS NAME

APPLICATION

30-13-203, MCA

LINDA McCULLOCH

MAIL:

Secretary of State

P.O. Box 202801

Helena, MT 59620-2801

PHONE:

(406) 444-3665

FAX:

(406) 444-3976

WEB SITE:

sos.mt.gov

Required Filing Fee: $20.00

 24 Hour Priority Handling check box & Add $20.00

 1 Hour Expedite Handling check box & Add $100.00

The Assumed Business Name is:

_____________________________________________________________________________________________

NOTE: An applicant for an assumed business name may not use a business name identifier that incorrectly states the type of

entity that it is, or incorrectly implies that it is a type of entity other than the type of entity that it is

30-13-202,

MCA.

The description of the business transacted under the Assumed Business Name:

_____________________________________________________________________________________________

The date the applicant first used the proposed assumed business name in commerce is (cannot be a future date):

_____________________________. If left blank, date of first use is date of filing in SOS office.

(month/day/year)

The applicant is (check only one and complete where appropriate):

 A Corporation and the name of the Corporation is:_________________________________________________

 A Limited Liability Company and the name of the LLC is:_____________________________________________

 Limited Liability Partnership and the name of the LLP is:_____________________________________________

 Limited Partnership and the name of the LP is:_____________________________________________________

 Association (Attach the names and business mailing addresses of all the members)

 A Partnership: (Attach the names and business mailing addresses of the partners)

 An Individual and the name of the individual is:____________________________________________________

The business mailing address of the Assumed Business name is as follows:

Business Mailing Address: ________________________________________________________________________

City:___________________________________________________ State:__________ Zip Code:________________

I, HEREBY SWEAR AND AFFIRM, under penalty of law, that the facts contained in this document are true.

_______________________________________________________________________

____________________

Signature of Applicant (all Partnerships & LLPs must have at least 2 signatures)

Date

Daytime Contact: Phone: ___________________________ Email: ______________________________________

01A-Assumed_Business_Name_Registration.doc

Revised: 6/17/13

Registration Of Assumed Business Name Application Form - State Of Montana - Secretary Of State

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