Cancellation Of Assumed Business Name Form - Montana Secretary Of State
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1Prepare, 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)
CANCELLATION of ASSUMED BUSINESS NAME
30-13-213, MCA
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 Fees:
Standard
None
Folder ID Number: ______________________
24 Hour Priority $ 20.00
The folder number begins with an “A” and may be referenced
1 Hour Expedite $100.00
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 complete registered Assumed Business Name to be canceled:
__________________________________________________________________________________________________________
2. The name and business mailing address of the applicant:
Name: ____________________________________________________________________________________________________
Business Mailing Address: ____________________________________________________________________________________
City:________________________________________________________ State:______________ Zip Code:__________________
3. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this
document are true.
__________________________________________________________________________________
_____________________
Signature of applicant (all Partnerships and LLPs must have at least two signatures)
Date
____________________________________________________________
___________________________________________
Printed Name
Title
4. Daytime Contact: Phone _____________________________________ Email __________________________________________
sos.mt.gov/Business/Forms
03-03-Cancellation_of_Assumed_Business_Name
Revised: 3/2017
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