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Statement Of Cancellation Of Non Reissuable Shares BCA-9.05 - Illinois
| Statement Of Cancellation Of Non Reissuable Shares Form. This is a Illinois form and can be used in Corporation Secretary Of State . |
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FORM BCA 9.05 (rev. Dec. 2003) STATEMENT OF CANCELLATION OF NON-REISSUABLE SHARES Business Corporation Act 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. ____________________________________ File #_____________________________ Filing Fee: $5 Approved: ____________ -------- Submit in duplicate -------- Type or Print clearly in black ink -------- Do not write above this line -------- 1. Corporate Name: ________________________________________________________________________________ 2. The Corporation has acquired and cancelled its own shares, and the Articles of Incorporation prohibit the re-issuance of such shares. 3. Number of shares cancelled and redemption or purchase price: Class Series Par Value ____________ _____________ ______________ ______________ Number of Shares Cancelled ______________ Redemption or Purchase Price ______________ Date of Cancellation BEFORE CANCELLATION Class Series Par Number Class AFTER CANCELLATION Series Par Number 4. Number of authorized shares: 5. Number of issued shares: 6. Paid-in capital: $_________________________ $_________________________ 7. 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. All signatures must be in BLACK INK. Dated _______________________________ , _____ Month & Day Any Authorized Officer's Signature Year ________________________________________________ Exact Name of Corporation ______________________________________ ______________________________________ Name and Title (type or print) NOTE: This fo rm is applicable only where the Articles of Incorporation provide that shares redeemed or purchased shall be cancelled and shall not be re-issued. Upon such redemption and cancellation of shares, the paid-in capital of the Corporation is deemed to be reduced by that part of the paid-in capital which was represented by the shares so cancelled. The filing of this statement operates as an amendment to the Articles of Incorporation and reduces the number of shares of the class so redeemed which the Corporation is authori zed to issue by the number of shares so redeemed and cancelled. Printed by authority of the State of Illinois. June 2006 - 1M - C 150.11 American LegalNet, Inc. www.USCourtForms.com
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