Statement Of Change Of Registered Agent And/or Registered Office Form - Montana Secretary Of State

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STATE OF MONTANA
Prepare, sign, submit with an original signature and filing fee
This is the minimum information required
(This space for use by the Secretary of State only)
STATEMENT of CHANGE
of REGISTERED AGENT
and/or REGISTERED OFFICE
:
LINDA McCULLOCH
MAIL
Secretary of State
P.O. Box 202801
Helena, MT 59620-2801
PHONE:
(406)444-3665
FAX:
(406)444-3976
WEBSITE:
sos.mt.gov
Required Filing Fee: No Fee
24 Hour Priority Handling check box and Add $20.00
1 Hour Expedite Handling check box and Add $100.00
For the purpose of having and continuously maintaining a registered agent at a registered office within the State of Montana, the
undersigned submits the following statements of fact to the Secretary of State in accordance with
35-7-108,
MCA, or
35-7-109,
MCA:
1.
The exact name of the entity: ______________________________________________________________________________
Registered Agent Information
2.
The name of the current registered agent: ________________________________________________________________
3.
The street or rural route box number and mailing address of the current registered office in Montana:
____________________________________________________________________________________________________
Street or Rural Route Box Number
____________________________________________________________________________________________________
Mailing Address
City: ______________________________________________________ State: MT Zip Code: ________________________
4.
The name of the newly appointed registered agent: ________________________________________________________
5.
The street or rural route box number and mailing address of the newly appointed registered office in Montana:
____________________________________________________________________________________________________
Street or Rural Route Box Number
____________________________________________________________________________________________________
Mailing Address
City: _____________________________________________________ State: MT Zip Code: _________________________
Signature of consent of agent if filing under
35-7-109,
MCA:
____________________________________________________________________________________________________
6.
I HEREBY SWEAR AND AFFIRM, under penalty of law, that the facts contained in this document are true and are signed on
behalf of the entity.
_________________________________________________________________
_____________________________
Signature of Authorized Person for Entity if filed under
35-7-108, MCA
Date
________________________________________________ _______________________ ______________________________
Printed Name and Title of above Authorized Person
Daytime Phone Number
Email
sos.mt.gov/Business/Forms
80-Statement_of_Change_of_Agent_and_Office.doc
Revised: 10/01/2013

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