Form 80c - Statement Of Change Of Noncommercial Registered Agent By Agent 35-7-109, Mca
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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)
STATEMENT of CHANGE of NONCOMMERCIAL REGISTERED
AGENT by AGENT
35-7-109, MCA
:
LINDA McCULLOCH
MAIL
Secretary of State
P.O. Box 202801
Helena, MT 59620-2801
PHONE:
(406)444-3665
FAX:
(406)444-3976
Required Filing Fee: None
WEBSITE:
sos.mt.gov
24 Hour Priority Handling check box and Add $20.00
1 Hour Expedite Handling check box and Add $100.00
Folder ID Number: _____________
The folder number begins with a “D, F, C, E” or “L” and may
be referenced at
https://app.mt.gov/bes/.
If the document is hand written, please print legibly or the application may be denied
.
1. The exact name of the entity: _________________________________________________________________________________
2. The name and address of the noncommercial registered agent as currently in effect:
Name:____________________________________________________________________________________________________
Address:__________________________________________________________________________________________________
3. The new name of the noncommercial registered agent, if applicable:
_______________________________________________________________________________________________________
4. The new address of the noncommercial registered agent, if applicable:
Actual Street Address or Rural Route Box Number in Montana: (Must be an actual geographic location.)
__________________________________________________________________________________________________________
City: _______________________________________________________ Zip Code: _____________________________________
And, a mailing address in Montana, if different:
__________________________________________________________________________________________________________
City: _______________________________________________________ Zip Code: _____________________________________
Appointment of a Registered Agent is affirmation of the Registered Agent’s consent to serve as Registered Agent.
5. A noncommercial registered agent shall promptly furnish the represented entity with notice in a record of the filing of statement
of change and the changes made by the filing.
6. I HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this
document are true.
__________________________________________________________________________
_____________________________
Signature of Noncommercial Registered Agent or Authorized Agent
Date
__________________________________________________________________________________________________________
Printed Name
7. Daytime Contact: Phone_________________________________ Email ______________________________________________
80C-Statement_of_Change_of_Noncommercial_Resident_Agent_by_Agent
sos.mt.gov/Business/Forms
New: 07/2015
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