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)
STATEMENT of RESIGNATION of REGISTERED AGENT
35-7-111, MCA
:
LINDA McCULLOCH
MAIL
Secretary of State
P.O. Box 202801
Helena, MT 59620-2801
P
:
(406) 444-3665
HONE
F
:
(406) 444-3976
AX
Required Filing Fee: None
W
S
:
sos.mt.gov
EB
ITE
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 name of the represented entity:
__________________________________________________________________________________________________________
2. The name of the registered agent: _____________________________________________________________________________
3. The name and address of the person to which the registered agent will send notification of their resignation:
Name: ____________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
City: _________________________________________ State: _____________________ Zip Code: _________________________
4. The registered agent resigns from serving as agent for service of process for the above-listed entity.
st
5. A statement of resignation takes effect on the earlier of the 31
day after the day on which it is filed or the appointment of a
new registered agent for the represented entity.
6. When a statement of resignation takes effect, the registered agent ceases to have responsibility for any matter tendered
to it as agent for the represented entity.
7. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this
document are true.
___________________________________________________________________________ _____________________________
Signature of Registered Agent or Authorized Agent
Date
____________________________________________________________
___________________________________________
Printed Name
Title
8. Daytime Contact: Phone_________________________________ Email ______________________________________________
81-Statement_of_Resignation_of_Registered_Agent
sos.mt.gov/Business/Forms
Revised: 07/2015