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Form BCA-4.10
(Rev. Jan. 2003) Secretary of State Department of Business Services Springfield, IL 62756 217-782-9520 www.cyberdriveillinois.com Payment must be made by check or money order payable to Secretary of State. ($25 fee for each name reserved.)
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Application for Reservation of Name
This space for use by Secretary of State.
File #: SUBMIT ONE ORIGINAL
This space for use by Secretary of State.
Date: Filing Fee: $ Approved:
1. Name(s) to be Reserved (for a period of 90 days each): _____________________________________________________________________________________________
Must contain the word "corporation," "company," "incorporated" or "limited," or contain an abbreviation of such words.
_____________________________________________________________________________________________ _____________________________________________________________________________________________ 2. Proposed Corporate Purpose: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. Name of Applicant: ______________________________________________________________________________ 4. Address of Applicant: ____________________________________________________________________________ _____________________________________________________________________________________________
5. Dated _______________________________ , _____
Month & Day Year
______________________________________________
Signature of Applicant
______________________________________________
Name (type or print)
NOTE: · If the applicant is an individual, this application must be signed by the applicant. · If the applicant is a corporation, this application must be signed by a duly authorized officer of the corporation. · Upon filing of this document, name(s) will be reserved for a period of 90 days.
Printed by authority of the State of Illinois. April 2006 -- 5M -- C 156.8
NOTICE OF TRANSFER OF RESERVED NAME
Date: Filing Fee: $25 Approved:
The undersigned _____________________________________________________________________ hereby transfers
Name of Original Applicant
to _______________________________________________________________________________ the right to use the
Name of Transferee
name __________________________________________________________________________for corporate purposes in Illinois. This name was reserved on ____________________________________, __________.
Month & Day Year
The undersigned affirms, under penalties of perjury, that the facts stated herein are true and correct. Dated _______________________________ , ______
Month & Day Year
by _________________________________________
Signature of Original Applicant
Attested by _ _________________________________
_________________________________________
Name (type or print)
* As the original applicant, I declare that this document has been examined by me and is to the best of my knowledge and belief, true, correct and complete.
Printed by authority of the State of Illinois. April 2006 -- 5M -- C 156.8