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) APPOINTMENT of AGENT by a NON-QUALIFIED FOREIGN BUSINESS ENTITY 35-7-112, 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: WEB SITE: Required Filing Fee: $70.00 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 name of the "non-qualified" Foreign Business Entity: __________________________________________________________________________________________________________ 2. 3. 4. The state, tribe, or country of organization: ______________________________________________________________________ The type of organization: ____________________________________________________________________________________ (Corporation, Limited Liability Company, or a Limited Partnership) The name of the entity's Commercial Registered Agent for service of process in Montana is: Name: ____________________________________________________________________________________________________ Or, the name and address of the entity's Noncommercial Registered Agent for service of process in Montana is: Name: ____________________________________________________________________________________________________ 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 Individual Date ____________________________________________________________ ____________________________________________ Printed Name Title 6. Daytime Contact: Phone_________________________________ Email ______________________________________________ sos.mt.gov/Business/Forms.asp 85-Appointment_of_Agent_by_Nonqualified_Foreign_Business_Entity Revised: 08/2016 American LegalNet, Inc. www.FormsWorkFlow.com