Free AFFIDAVIT OF COMPLIANCE FOR SERVICE ON SECRETARY OF STATE UNDER THE BUSINESS CORPORATION ACT - Illinois

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BCA-5.25

(Rev. Jan. 2003)

AFFIDAVIT OF COMPLIANCE FOR SERVICE ON SECRETARY OF STATE UNDER THE BUSINESS CORPORATION ACT This space for use by Secretary of State.

File #

Jesse White Secretary of State Department of Business Services Springfield, IL 62756 217-524-6748 www.cyberdriveillinois.com Remit payment in check or money order payable to Secretary of State.

SUBMIT IN DUPLICATE

Date: Filing Fee: $10 Approved:

1.

Title and Number of Case: ______________________________________ first named plaintiff v. ______________________________________ first named defendant Number ______________

2. 3. 4. 5.

Name of corporation being served: ________________________________________________________ Title of court in which an action, suit or proceeding has been commenced: _________________________ Title of instrument being served: __________________________________________________________ Basis for service on the Secretary of State: (check and complete appropriate box) a. b. c.



The corporation's registered agent cannot with reasonable diligence be found at the registered office of record in Illinois. The corporation has failed to appoint and maintain a registered agent in Illinois. The corporation was dissolved on ___________________________ , _________ ; the conditions
Month & Day Year

of paragraphs (a) or (b) above exist; and the action, suit or proceeding has been instituted against or has affected the corporation within five (5) years thereafter. d. e. 6.



The corporation's authority to transact business in Illinois has been withdrawn/revoked (circle one) on ________________________ , ___________ .
Month & Day Year

The corporation is a foreign corporation that has transacted business in Illinois without procuring authority, contrary to the provisions of the Business Corporation Act of 1983.

Address to which the undersigned will cause a copy of the attached process, notice or demand to be sent by certified or registered mail: _______________________________________________________________ The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete. _________________________________________ _____________________________ ___________
Signature of Affiant Month & Day Year

7.

(0000000) __________________________________________
Telephone Number

Return to (please type or print clearly): ____________________________________
Name

____________________________________
Street

____________________________________
City/Town State ZIP Printed by authority of the State of Illinois. June 2005 -- 5M -- C 213.10

INSTRUCTIONS
Deliver to the Secretary of State: 1. Copy of process, notice or demand; 2. Copy of any papers to be served therewith; 3. Affidavit of Compliance for Service on Secretary of State; and 4. $10 fee. This affidavit will be stamped with the date of filing and returned to the affiant as the only proof of filing. After proof of filing has been received, transmit to the corporation being served by CERTIFIED or REGISTERED mail: 1. Copy of process, notice or demand; 2. Copy of any papers to be served therewith; 3. Copy of filed Affidavit of Compliance for Service on Secretary of State. Transmittal to the corporation being served shall be: 1. At the last registered office of the corporation as shown on the records of the Secretary of State; AND 2. At such address the use of which the person instituting the action, suit or proceeding knows, or on the basis of reasonable inquiry has reason to believe, is most likely to result in actual notice.

Printed by authority of the State of Illinois. June 2005 -- 5M -- C 213.10