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STATEOFMONTANA Prepare, sign, submitwithoriginalsignatureandfilingfee. Thisistheminimuminformationrequired. (ThisspaceforusebytheSecretaryofStateonly) CERTIFICATEofAUTHORITY forFOREIGNRELIGIOUSCORPORATIONSOLE
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This form is a requirement for reporting minimum essential coverage under the Affordable Care Act.
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Information such as the names and social security numbers of individuals covered, the months of coverage, and information about the provider of the coverage must be reported on this form.
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