Prepare, sign, submit with an original signature and filing fee.
STATE OF MONTANA
This is the minimum information required.
(This space for use by the Secretary of State only)
CERTIFICATE of WITHDRAWAL
of FOREIGN NONPROFIT CORPORATION
APPLICATION
LINDA McCULLOCH
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
Filing Fee: $15.00
24 Hour Priority Filing Add $20.00
1 Hour Expedite Filing Add $100.00
For the purpose of withdrawing from the State of Montana as a nonprofit corporation (35‐2‐831, MCA), the undersigned submits the
following statements of fact to the Secretary of State:
1. The name of the corporation: ______________________________________________________________________________
2. It is incorporated under the laws of: _________________________________________________________________________
3. It is not transacting business or conducting affairs in Montana and it hereby surrenders its authority to transact business and
conduct affairs in Montana.
4. It revokes the authority of its registered agent in Montana to accept service of process and consents that service of process in any
action, suit or proceeding based upon any cause of action arising in Montana may thereafter be made on it by service thereof on the
Secretary of State of the State of Montana.
5. Provide a mailing address to which the Secretary of State may mail a copy of any process against the corporation served on him:
______________ ______________________________________________
(Street number) (Street)
_______________________________________________ ________________________ ____________________
(City or town)
(State)
(Zip code)
6. It will notify the Secretary of State should any other changes be made in its mailing address.
7. If it was involved in a merger, the name of the surviving corporation is:
_____________________________________________________________________________________________________
And its state of jurisdiction is: _____________________________________________________________________________
8. The mailing address of the surviving corporation is:
______________________________________________________________________________________________________
(Street number) (Street)
_______________________________________________ ________________________ ____________________
(City or town)
(State)
(Zip code)
The execution of any document required to be filed with the Secretary of State constitutes an affirmation, under penalties of false
swearing, by each person executing the document that the facts stated therein are true. (35‐1‐428, MCA)
_____________________________________________________________________________________________________________
Exact name of corporation
_________________________________________________ _________________________________________________
Signature of officer or chairman of board
Title
_________________________________________________
_____________________________
Printed name of individual signing
Date
(Mo/Day/Yr)
66‐Foreign_Nonprofit_Corporation_Certificate_of_Withdrawal.doc
Revised: 1/5/2009