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444. 2040 800. 332. 6148 Fax 406. 444. 3497 www. csimt. gov APPLICATION FOR CROWDFUNDING EXEMPTION Pursuant to Montana Code Annotated Section 30-10-105 22 Please fill out this form and submit it with a 50. In WITNESS WHEREOF I have hereunto set my hand and official seal. Notary Public/Commissioner of Oaths My Commission Expires SEAL. 00 filing fee to Office of the Montana State Auditor Securities Department 406 444-2040 Name of Issuer Address of Issuer Phone Number 1. 80a-3 or subject to the...

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