Form Fc-10 - Application For Certificate Of Withdrawal Of Foreign Profit Corporation - Mt Secretary Of State - 2001
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1Prepare, sign and submit an ORIGINAL AND COPY with fee.
STATE OF MONTANA
(This space for use by the Secretary of State only)
APPLICATION for CERTIFICATE
of WITHDRAWAL of FOREIGN PROFIT
CORPORATION
MAIL:
BOB BROWN
Secretary of State
P.O. Box 202801
Helena, MT 59620-2801
Form:FC-10
PHONE:
(406)444-3665
Filing Fee: $15.00
FAX:
(406)444-3976
= =
Priority Filing Add $20.00
WEB SITE:
For the purpose of withdrawing from the State of Montana as a profit corporation (35-1-1037, MCA) the undersigned submits the following
statements of fact to the Secretary of State and attaches hereto a certificate by the Department of Revenue to the effect that the
Department of Revenue is satisfied from the available evidence that all taxes imposed by Title 15 Montana Code Annotated have
been paid:
1.
The name of the corporation is _______________________________________________________________________________
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)
WARNING
“PENALTIES IMPOSED UPON OFFICERS AND DIRECTORS. 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.” (Section 35-1-428, MCA)
__________________________________________________________________________________________________________
Signature of Officer/Chairman of Board
Title
Date
Please be advised that the Business Services Bureau of the Montana Secretary of State will process your business documents
within 10 working days of initial receipt. During this period if it is determined that your document does not meet statutory
requirements, a letter outlining the deficiencies will be returned to the original submitter. If the document is complete and
correct, the document will be filed and an acknowledgment copy showing completion returned to the original submitter.
s:\forms\fc-10
Revised: 01/02/2001
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