Prepare, sign, and submit with and 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 LIMITED LIABILITY COMPANY
Secretary of State
P.O. Box 202801
Helena, MT 59620-2801
Required Filing Fees:
24 Hour Priority
Folder ID Number: ________________
1 Hour Expedite
The folder number begins with an “E” and may be
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 name of the Limited Liability Company:______________________________________________________________________
2. State, tribe, or country of organization:_________________________________________________________________________
3. The Limited Liability Company is not transacting business or conducting affairs in Montana and it hereby surrenders its authority
to transact business in Montana.
4. The Limited Liability Company revokes the authority of its registered agent in Montana to accept service 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 transact business in this state.
5. The Secretary of State may mail a copy of any process served on the Secretary of State to the following mailing address:
City: ____________________________________________ State: ______________________ Zip Code: ____________________
6. The Limited Liability Company will notify the Secretary of State in the future of any change in its business mailing address.
7. A certificate from the
Montana Department of Revenue
stating that all taxes imposed pursuant to
MCA, have been
paid must be attached. You may contact them at (406) 444‐6900; PO Box 5805, Helena, MT 59620‐5805.
8. OPTIONAL –The reason for filing this withdrawal is:________________________________________________________________
9. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this
document are true.
Signature of Managing Manager/Managing Member
10. Daytime Contact: Phone ___________________________________ Email _____________________________________________