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Application To Adopt Change Or Cancel An Assumed Corporate Name Non Profit NFP-104.15-20 - Illinois
| Application To Adopt Change Or Cancel An Assumed Corporate Name Non Profit Form. This is a Illinois form and can be used in Corporation Secretary Of State . |
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Form NFP 104.15/20 (Rev. Jan. 2003) Secretary of State Jesse White Department of Business Services 501 S. Second St., Rm. 350 Springfield, IL 62756 217-782-9520 www.cyberdriveillinois.com Payment may be made by check payable or money order to Secretary of State. If check is returned for any reason this filing will be void. Please do not send cash. Application to Adopt, Change or Cancel an Assumed Corporate Name Under the General Not for Profit Corporation Act SUBMITINDUPLICATE Please type or print clearly. Filing Fee: $ (See Note Below) FILE # This space for use by Secretary of State. Approved: 1. Corporate Name: ________________________________________________________________________________ 2. State or Country of Incorporation: ___________________________________________________________________ 3. Date Incorporated (if an Illinois corporation) or Date Authorized to Transact Business in Illinois (if a foreign corporation): _____________________________________, ___________. Month & Day Year Complete No. 4 and No. 5 if adopting or changing an assumed corporate name. 4. Corporation intends to adopt and to transact business under the Assumed Corporate Name of: ______________________________________________________________________________________________ 5. The right to use the Assumed Corporate Name shall be effective from the date this application is filed by the Secretary of State until ____________________________________, __________, the first day of the corporations anniversary Month & Day Year month in the next year evenly divisible by five. Complete No. 6 if changing or cancelling an assumed corporate name. 6. Corporation intends to cease transacting business under the Assumed Corporate Name of: ______________________________________________________________________________________________ 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. Dated _______________________________ , _____ Month & Day Any Authorized Officers Signature Year ________________________________________________ Exact Name of Corporation ______________________________________ ______________________________________ Name and Title (type or print) NOTE: · The filing fee to adopt an assumed corporate name is $150 if the current year ends with a 0 or 5; $120 if the current year ends with a 1 or 6; $90 if the current year ends with a 2 or 7; $60 if the current year ends with a 3 or 8; or $30 if the current year ends with a 4 or 9. · The fee for cancelling an assumed corporate name is $5. · The fee to change an assumed corporate name is $5. Printed by authority of the State of Illinois. March 2013 -- 1 -- C 211.7 American LegalNet, Inc. www.FormsWorkFlow.com
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