MONTANA Form M-2 Rev 02 11 Secured Party Termination Name of Borrower/Debtor _________________________________________________________________________________________________ Address _________________________________________________________________________________________________ Street City State Zip Name of Lender/Secured Party _________________________________________________________________________________________________ Address _________________________________________________________________________________________________ Street City State Zip License No. - - - Doing Business As______________________________________ Loan No.____________________ Location Address _______________________________________________________ The undersigned no longer claims security interest in the above license and hereby requests that the name listed above as secured party be removed from the face of the license. Dated this ___________day of ________________, 20________ Signature of Lender/Secured Party __________________________________________________ Signature Title Date __________________________________________________ Printed Name __________________________________________________ Signature Title Date __________________________________________________ Printed Name Return to: Montana Department of Revenue Liquor Licensing PO Box 1712 Helena, MT 59624-1712 *11MX0101* *11MX0101* American LegalNet, Inc. www.FormsWorkFlow.com