Fill and Sign the Assumed Business Name or Form

P:\Forms\abn\03-Assumed_Business_Name_Cancellation.doc Revised 09/01/2006 STATE OF MONTANA NOTICE of CANCELLATION of ASSUMED BUSINESS NAME or LIMITED LIABILITY PARTNERSHIPS (30-13-213, MCA) MAIL: BRAD JOHNSON Secretary of State P.O. Box 202801 Helena, MT 59620-2801 PHONE: (406)444-3665 FAX: (406)444-3976 WEB SITE: sos.mt.gov Prepare, sign and submit with the proper filing fee. This is the minimum information required. (This space for use by the Secretary of State only) No Fee ฀ 24 Hour Priority Filing Add $20.00 ฀ 1 Hour Expedite Filing Add $100.00 P LEASE CHECK ONE BOX : … Cancellation of ABN (30-13-213, MCA) … Cancellation of LLP (30-13-213, MCA) 1. The Assumed Business Name or LLP to be canceled is: If the document is hand written, please prin t legibly or the application may be denied 2. The name and address of the original applicant are as follows: Name: Street Address: City: State: Zip Code: I, H EREBY SWEAR AND AFFIRM , under penalty of law, that the facts c ontained in this Application are true. Signature of Applicant Title/Ownership Interest in Business Organization Daytime Contact: Phone_____________________Email________________________ State of: County of: Signed or attested before me on: (date) by [name(s) of person(s)] Signature of notary: Printed name of notary public: Notary public for the state of: Residing at: My commission expires: ™ All information provided, including na mes and addresses of officers and direct ors, will be made available on the Secretary of State’s web site or upon request. ™ There are important legal and accounting implications with respect to this corporation action. Suitable legal and accounting advice should be secured before submission. Th e Secretary of State’s office encourages that such advice be sought prior to filling out forms to be su re that you understand the terms and procedures. ™ Please be advised that the Business Services Bureau of the Montana Secretary of State will process your business documents within 10 working d ays of initial receipt. During this period if it’s determined that your document doesn’t meet statutory requirements, a lett er outlining the deficiencies will be returned to the original submitter. If the document is complete and correct, the document will be filed and an acknowledgment copy showing completion returned to the original submitter. P:\Forms\abn\03-Assumed_Business_Name_Cancellation.doc Revised 6/17/2004 Application for Cancellation of Assumed Business Name or LLP HELP SHEET Please type or clearly print the requested information. Filing Fee . Please submit this form with an ORIGINAL signatu re. You may request 24 Hour priority filing or 1 Hour Expedite Filing of your document. Simply mark the “24 Hour Priority Filing” box and include a $20.00 priority handling fee or mark the “1 Hour Expedite F iling” box and include a $100.00 fee. Priority filing ensures that your application will be handled within 24 hours of r eceipt of the document by our office. 1 Hour Expedite Filing ensures that your application will be handled w ithin 1 hour of receipt of the document by our office. Notary Requirement . Please be sure to have the form notarized. Submission . Upon completion, mail with ORIGINAL SIGNATURE to the Secretary of State, PO Box 202801, Helena, MT 59620-2801. Make checks payable to the Secretary of State. Compliance Review . The Secretary of State’s office will review th is form and send a letter of acknowledgment to you once your document has met statutory requirements and has been filed with our office. You will receive a letter outlining any deficiencies if your document does not meet statutory requirements. All information provided, including names and addresses of officers and directors, will be made available on the Secretary of State’s web site or upon request. If you have any questions regarding this form, please cont act the Secretary of State, Business Services Bureau at (406) 444-3665.