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Domestic Corporation Annual Report - Illinois

Domestic Corporation Annual Report Form. This is a Illinois form and can be used in Corporation Secretary Of State .
 Fillable pdf Last Modified 6/21/2011
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YEAR OF: File Prior to: STATE OF ILLINOIS DOMESTIC CORPORATION ANNUAL REPORT CORPORATION File #: ________________ Note: A change in the Registered Agent and/or Registered Office may only be effected by filing Form BCA-5.10/5.20. If there have been any changes in items 6 or 7a, Form BCA-14.30 must be completed and submitted in the same envelope. 1. Corporate Name: Registered Agent: Registered Office: City, IL, ZIP Code: Street County: City State ZIP Code 2. 3. 4. Principal Address of Corporation: ____________________________________________________________________________ Date Incorporated:__________________________________ Month Day Year Names and Addresses of Officers and Directors: NOTE: The names and addresses of ALL officers and directors must be entered in this item. OFFICE President Secretary Treasurer Director Director Director NAME NUMBER& STREET CITY STATE ZIP 5. 6. If 51% or more of stock is owned by a minority or female, please check appropriate box: Minority Owned Number of shares authorized and issued (as of ________________________): SERIES PAR VALUE NUMBER AUTHORIZED Female Owned CLASS President Secretary Treasurer Director Director NUMBER ISSUED Director IMPORTANT: If the amount in item 6 or 7a differs from the Secretary of States records, form BCA 14.30 must be completed. 7a. 7b. 8. Amount of Paid-in Capital (as of ___________________ ): $ _________________ Paid-in Capital on record with Secretary of State: $ _________________________ By: _______________________________________________________________ Any Authorized Officers Signature Title Date (Paid-in Capital reflects the sum of the Stated Capital and Paid-in surplus accounts.) Under the penalty of perjury and as an authorized officer, I declare that this annual report, pursuant to provisions of the Business Corporation Act, has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Item 8 Must Be Signed. RETURNTO: Jesse White, Secretary of State Department of Business Services · 501 S.Second St. · Springfield, IL 62756 217-782-7808 · www.cyberdriveillinois.com Please Complete Reverse Side of This Report PRESIDENT SECRETARY IF THE ABOVE OFFICER'S NAMES AND ADDRESSES ARE MISSING OR HAVE CHANGED, ENTER ONLY THE ADDITION OR CORRECTIONS BELOW. Name Street Address City State _______________ File # ZIP Code PRESI DENT _________________________________________________________________________________________________ SECRETARY_________________________________________________________________________________________________ Name Street Address City State ZIP Code American LegalNet, Inc. www.FormsWorkFlow.com Printed by authority of the State of Illinois. July 2011 -- 5M -- C 289.9 (Item 9 OR 10a OR 10b, whichever is applicable, MUST be completed.) 9. Amounts stated in parts (a) through (d) below are given for the 12-month period ending ________________________________________ , ________________. Day Month Year Value of property (gross assets): (a) owned by the corporation, wherever located: ............................................................. (a) (b) of the corporation located within the State of Illinois:.................................................. (b) Gross amount of business transacted by the corporation: (c) everywhere for the above period: ............................................................................... (c) (d) at or from places of business in Illinois for the above period: ..................................... (d) $ ______________________ $ ______________________ $ ______________________ $ ______________________ ALLOCATION FACTOR = b+d a+c = = ____________________ Enter this figure on line 11b below. 6 decimal places . 10a. ALL property of the Corporation is located in Illinois and ALL business of the Corporation is transacted at or from places of business in Illinois. 10b. The Corporation elects to pay franchise tax on the basis of 100% of its total Paid-in Capital. ALLOCATIONFACTOR = 1.00000 (Enter this figure on line 11b below.) STOP: Item 9 or 10 must be completed before continuing to Item 11. 11. 11a. ANNUAL FRANCHISE TAX AND FEES TOTAL PAID-IN CAPITAL (Enter amount from Item 7a; a. if late, enter the greater of 7a or 7b.) ....................................................................._________________________ b. ALLOCATION FACTOR (Enter from Item 9 or Item 10.)........................................_________________________ c. ILLINOIS CAPITAL (Multiply line 11a by line 11b.).................................................________________________ 11b. 11c. 11d1. Multiply line 11c by .001 (Round to nearest cent.) ................................................. d1 11d2. ANNUAL FRANCHISE TAX (Enter amount from line d1, but not less than $25)................................................... d2. e1. 11e1. If Annual Report is late, multiply line d2 by .10 ......................................................________________________ 11e2. If Annual Franchise Tax is late, multiply line d2 by .02 for each month e2. late or part thereof (minimum $1)...........................................................................________________________ 11e3. INTEREST & PENALTIES (Add lines e1 and e2.) ................................................................................................. e3. 11f. 11g. ANNUAL REPORT FILING FEE ($75) .................................................................................................................. 11f. TOTAL ANNUAL FRANCHISE TAX, FEES, INTEREST, PENALTIES DUE (Add line d2 + line e3 + line f.) ............................................................................................................................... 11g. $75.00 MAKE CHECKS PAYABLE TO ILLINOIS SECRETARY OF STATE. (Place corporate file number on check.) IMPORTANT: If there have been changes in Items 6 or 7, Form BCA 14.30 must be executed and submitted with this Annual Report in the same envelope. Printed by authority of the State of Illinois. July 2011 -- 5M -- C 289.9 American LegalNet, Inc. www.FormsWorkFlow.com
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