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STATE OF MONTANA

Prepare, sign and submit with the proper filing fee.

This is the minimum information required.

AMENDMENT to REGISTRATION of

ASSUMED BUSINESS NAME

(This space for use by the Secretary of State only)

APPLICATION

30-13-210, MCA

MAIL:

LINDA McCULLOCH

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 Fee: $20.00

24 Hour Priority Handling check box and Add $20.00

1 Hour Expedite Handling check box and Add $100.00

If the document is hand written, please print legibly or the application may be denied.

1. The complete current name of ABN is: _______________________________________________________________

(Name of ABN prior to this amendment)

The complete new name if amended is: ______________________________________________________________

3. The name and business mailing address of the applicant/owner is:

_______________________________________________________________________________________________

(Must list all owners/partners/members registered with the office of the Montana Secretary of State prior to this amendment.)

4. The name(s) and business mailing address(es) of persons no longer transacting or having an interest in the business

being conducted under this name are (State reason which could include withdrawal or death.) :

_______________________________________________________________________________________________

(For additional names, attach a separate sheet of paper)

5. The name(s) and business mailing address(es) of new persons or entities transacting or having an interest in the

business being conducted under this name are:

_______________________________________________________________________________________________

(For additional names, attach a separate sheet of paper)

6. If the applicant type has changed (check one and complete where appropriate):

A Corporation

A Limited Liability Company

A Limited Liability Partnership

A Limited Partnership

An Association (Attach list of names and addresses of members)

A Partnership (Attach list of names and addresses of partners)

An Individual

7. The description of business is amended to read: _______________________________________________________

8. This amendment supersedes the original registration and all amendments to the original registration.

9. I

, under penalty of law, that the facts contained in this application are true.

HEREBY SWEAR AND AFFIRM

________________________________________________________________________ ______________________

Signature of Applicant currently listed with the Montana Secretary of State

Date

Daytime Contact: Phone _______________________________ Email ______________________________________

sos.mt.gov/Business/Forms

02-Amendment_to_Registration_of_ABN.doc

Revised: 06/13/2012

Amendment To Registration Of Assumed Business Name Application - Montana Secretary Of State - 2012

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