Prepare, sign, and submit with an original signature and filing fee. This is the minimum information required. STATE OF MONTANA (This space for Secretary of State use only) STATEMENT of CHANGE of REGISTERED AGENT by ENTITY 35-7-108, MCA MAIL: LINDA McCULLOCH Secretary of State P.O. Box 202801 Helena, MT 59620-2801 (406)444-3665 (406)444-3976 sos.mt.gov PHONE: FAX: WEBSITE: Folder ID Number: _____________ The folder number begins with a "D, F, C, E" or "L" and may be referenced at https://www.mtsosfilings.gov. If the document is hand written, please print legibly or the application may be denied. 1. 2. Required Filing Fee: None 24 Hour Priority Handling check box and Add $20.00 1 Hour Expedite Handling check box and Add $100.00 The exact name of the entity: _________________________________________________________________________________ The name and address of the registered agent as currently in effect: Name:____________________________________________________________________________________________________ Address:__________________________________________________________________________________________________ 3. 4. The new name of the registered agent, if applicable:_______________________________________________________________ The new address of the registered agent, if applicable: Actual Street Address or Rural Route Box Number in Montana: (Must be a geographic location.) __________________________________________________________________________________________________________ City: ____________________________________________________ State: MT Zip Code: ________________________________ And, a mailing address in Montana, if different: __________________________________________________________________________________________________________ City: ____________________________________________________ State: MT Zip Code: ________________________________ Appointment of a Registered Agent is affirmation of the Registered Agent's consent to serve as Registered Agent. 5. I HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this document are true. ___________________________________________________________________________ ____________________________ Signature of Authorized Agent for Entity Date ____________________________________________________________ Printed Name ___________________________________________ Title 6. Daytime Contact: Phone_________________________________ Email _____________________________________________ sos.mt.gov/Business/Forms 80-Statement_of_Change_of_Registered_Agent_by_Entity Revised: 09/2016 American LegalNet, Inc. www.FormsWorkFlow.com