STATE OF MONTANA APPLICATION for REVIVER for DOMESTIC or FOREIGN CORPORATION 15-31-524, MCA MAIL: Prepare, sign, and submit with and original signature and filing fee. This is the minimum information required. (This space for Secretary of State use only) PHONE: FAX: WEB SITE: Secretary of State P.O. Box 202801 Helena, MT 59620-2801 (406) 444-3665 (406) 444-3976 sos.mt.gov LINDA McCULLOCH Required Filing Fee: Domestic and Foreign Reviver $15.00 plus Annual Reports 24 Hour Priority Handling check box and Add $20.00 1 Hour Expedite Handling check box and Add $100.00 Make checks payable to Secretary of State. If the document is hand written, please print legibly or the application may be denied. 1. The exact name of the Corporation: ________________________________________________________________________________________________________ 2. 3. The Corporation submits with this application a Title 15, MCA, certificate obtained from the Department of Revenue evidencing payment of delinquent taxes. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this application are true. __________________________________________________________________________ ____________________________ Signature of Presiding Officer of the Board of Directors, President, or other Officer Date ___________________________________________________________ Printed Name 4. ___________________________________________ Title Daytime Contact: Phone ______________________________ Email _______________________________________________ sos.mt.gov/Business/Forms 39B-Reviver_Domestic_or_Foreign_Corporation.doc.doc Revised: 7/2015 American LegalNet, Inc. www.FormsWorkFlow.com