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) CANCELLATION of ASSUMED BUSINESS NAME 30-13-213, 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: Folder ID Number: ______________________ The folder number begins with an "A" 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. The complete registered Assumed Business Name to be canceled: Required Filing Fee: None 24 Hour Priority Handling check box and Add $20.00 1 Hour Expedite Handling check box and Add $100.00 __________________________________________________________________________________________________________ 2. The name and business mailing address of the applicant: Name: ____________________________________________________________________________________________________ Business Mailing Address: ____________________________________________________________________________________ City:________________________________________________________ State:______________ Zip Code:__________________ 3. I, HEREBY SWEAR AND/OR AFFIRM, under penalty of law, including criminal prosecution, that the facts contained in this document are true. __________________________________________________________________________________ Signature of applicant (all Partnerships and LLPs must have at least two signatures) ____________________________________________________________ Printed Name 4. _____________________ Date ___________________________________________ Title Daytime Contact: Phone _____________________________________ Email __________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com sos.mt.gov/Business/Forms 03-03-Cancellation_of_Assumed_Business_Name Revised: 09/2016