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Report Following Merger Or Consolidation BCA-14.35 - Illinois
| Report Following Merger Or Consolidation Form. This is a Illinois form and can be used in Corporation Secretary Of State . |
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Form BCA-14.35 (Rev. Jan. 2003) Secretary of State Department of Business Services Springfield, IL 62756 217-782-6961 www.cyberdriveillinois.com Remit payment in the form of a check or money order, payable to Secretary of State. Report Following Merger or Consolidation File #: DO NOT SEND CASH This space for use by Secretary of State Date: Franchise Tax: Filing Fee: Penalty: Interest: Approved: $ $5 $ $ 1. Corporate Name: ________________________________________________________________________________ 2. State or Country of Incorporation: ___________________________________________________________________ 3. Issued shares of each corporation party to the merger prior to the merger: Corporation Class Series Par Value Number of Shares _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 4. Paid-in Capital of each corporation party to the merger prior to the merger: Corporation Paid-in Capital _________________________________________________________________________________________________ $ _________________________________________________________________________________________________ $ _________________________________________________________________________________________________ $ _________________________________________________________________________________________________ $ _________________________________________________________________________________________________ $ _________________________________________________________________________________________________ 5. Description of merger: (Include effective date and brief explanation of the conversion as stated in the plan of merger.) 6. Issued shares after merger: Class Series Par Value Number of Shares _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. Paid-in Capital of the surviving or new corporation: $ ________________ ("Paid-in Capital" replaces the terms Stated Capital and Paid-in Surplus and is equal to the total of these accounts.) ITEM 8 MUST BE SIGNED 8. The undersigned corporation has caused this statement to be signed by a duly authorized officer who affirms, under penalties of perjury, that the facts stated herein are true and correct. Dated _______________________________ , _____ Month & Day Any Authorized Officer's Signature Year ________________________________________________ Exact Name of Corporation ______________________________________ ______________________________________ Name and Title (type or print) Printed by authority of the State of Illinois. June 2006 -- 5M -- C 243.3 American LegalNet, Inc. www.USCourtForms.com
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