Prepare, sign, and submit with an original signature and filing fee.
This is the minimum information required.
STATE OF MONTANA
(This space for Secretary of State use only)
APPLICATION for CERTIFICATE of WITHDRAWAL
of FOREIGN NONPROFIT CORPORATION
Secretary of State
P.O. Box 202801
Helena, MT 59620-2801
Required Filing Fees:
Folder ID Number: _____________
24 Hour Priority $ 35.00
The folder number begins with an “F” and may be
1 Hour Expedite $115.00
referenced at https://
Make checks payable to Secretary of State
If the document is hand written, please print legibly or the application may be denied.
1. The exact name of the Corporation: ___________________________________________________________________________
2. The state, tribe, or country of incorporation: ____________________________________________________________________
3. The Corporation is not transacting business in Montana and it surrenders its authority to transact business and conduct affairs in
4. The Corporation revokes the authority of its registered agent in Montana to accept service of process on its behalf and appoints
the Secretary of State as its agent for service of process in any proceeding based on a cause of action arising during the time it
was authorized to do business in Montana.
5. Provide a business mailing address to which the Secretary of State may mail a copy of any process against the Corporation
served on the Secretary of State:
Business mailing address: ____________________________________________________________________________________
City: ____________________________________________ State: ______________________ Zip Code: ____________________
6. The Corporation will notify the Secretary of State should any other changes be made in its mailing address.
7. OPTIONAL - The reason for filing this withdrawal:_________________________________________________________________
8. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this
document are true.
Signature of Presiding Officer of the Board of Directors, President, or other Officer
9. Daytime Contact: Phone __________________________________________Email _____________________________________