Montana Limited Liability Company Annual Report Page 2
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25. Names and addresses of registered Businesses (managers or members):
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INSTRUCTIONS FOR REMOVING MEMBER OR MANAGER
DOMESTIC:
* Managed by Members - A member cannot be removed from the annual report. A dissociated (withdrawn) member
or a limited liability company must complete a Statement of Dissociation to remove a member. The Statement of
Dissociation must state the name of the limited liability company and the name of the specific member that is being
dissociated from the company. The Statement of Dissociation must be signed by a listed member. The filing fee is
$15.00 per Statement of Dissociation, and you must file one statement for each member being removed.
*Managed by Managers - A manager can be removed from the annual report, however, you must indicate next to
his/her name that the manager is not also a member. If the manager is also a member, a Statement of Dissociation is
required for removal (see above).
FOREIGN:
*Managed by Members or Managers - Members or Managers can be removed from the annual report without any
requirements.
Simply cross out the name or indicate “Removed.”
6. Professional Limited Liability Companies only. I certify that all the members and not less than one-half of the
managers are qualified with the proper licensing authority in Montana or meet higher standards as specified by that
licensing authority.
7. BY MY SIGNATURE BELOW, I, A MEMBER OF THE ABOVE LIMITED LIABILITY COMPANY AUTHORIZED TO EXECUTE
DOCUMENTS ON ITS BEHALF, DO STATE THAT ANY AND ALL STATEMENTS CONTAINED HEREIN ARE TRUE AND ARE
BASED UPON ACTIONS TAKEN BY THE LLC IN ACCORDANCE WITH THE STATUTES OR ITS ARTICLES OF
ORGANIZATION OR OPERATING AGREEMENT.
I FURTHER STATE THAT THE LLC REMAINS IN EXISTENCE AND HAS TAKEN THE NECESSARY ACTIONS DURING THE
PAST YEAR TO PRESERVE THE STATUS.
X_____________________________________________ __
_____________________________________ ___________________
SIGNATURE OF MEMBER
PRINTED NAME OF MEMBER SIGNING
DATE
MEMBER ADDRESS________________________________________________________________________________________
ALL INFORMATION PROVIDED, INCLUDING NAMES AND ADDRESSES OF MEMBERS OR MANAGERS, WILL BE
MADE AVAILABLE ON THE SECRETARY OF STATE’S WEB SITE OR UPON REQUEST.
SIGN AND INCLUDE CORRECT FILING FEE:
PLEASE SEND FEE AND COMPLETED REPORT TO:
$15, IF FILED ON OR BEFORE APRIL 15TH
BOB BROWN (406) 444-3665
$30, IF FILED AFTER APRIL 15TH
SECRETARY OF STATE
PO BOX 202802
MAKE CHECKS PAYABLE TO SECRETARY OF STATE
HELENA MT 59620-2802
s:\forms\annual.llc
Revision: 2/5/2002
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