Prepare, sign, and submit with and original signature and filing fee. This is the minimum information required STATE OF MONTANA (This space for Secretary of State use only) APPLICATION for CERTIFICATE of WITHDRAWAL of FOREIGN LIMITED LIABILITY COMPANY 35-8-1010, 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: $15.00 24 Hour Priority Handling check box and Add $20.00 1 Hour Expedite Handling check box and Add $100.00 Folder ID Number: ________________ Make checks payable to Secretary of State. The folder number begins with an "E" 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. 3. The name of the Limited Liability Company:______________________________________________________________________ State, tribe, or country of organization:_________________________________________________________________________ The Limited Liability Company is not transacting business or conducting affairs in Montana and it hereby surrenders its authority to transact business in Montana. The Limited Liability Company revokes the authority of its registered agent in Montana to accept service on its behalf and appoints the Secretary of State as its agent for service of process in any proceeding based on a cause of action arising during the time it was authorized to transact business in this state. The Secretary of State may mail a copy of any process served on the Secretary of State to the following mailing address: Street Address:_____________________________________________________________________________________________ City: ____________________________________________ State: ______________________ Zip Code: ____________________ 6. 7. 8. The Limited Liability Company will notify the Secretary of State in the future of any change in its business mailing address. A certificate from the Montana Department of Revenue stating that all taxes imposed pursuant to Title 15, MCA, have been paid must be attached. You may contact them at (406) 4446900; PO Box 5805, Helena, MT 596205805. OPTIONAL ­The reason for filing this withdrawal is:________________________________________________________________ __________________________________________________________________________________________________________ 9. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this document are true. ___________________________________________________________________________ _____________________________ Signature of Managing Manager/Managing Member Date 10. Daytime Contact: Phone ___________________________________ Email _____________________________________________ 4. 5. sos.mt.gov/Business/Forms 29A-Certificate_of_Withdrawal_of_Foreign_LLC Revised: 09/2016 American LegalNet, Inc. www.FormsWorkFlow.com