Free Application to Adopt, Change or Cancel an Assumed Corporate Name - Illinois

Print
Form BCA-4.15/4.20
(Rev. Jan. 2003) Secretary of State Department of Business Services Springfield, IL 62756 217-782-9520 www.cyberdriveillinois.com Remit payment in the form of a check or money order, payable to Secretary of State.

Reset

Application to Adopt, Change or Cancel an Assumed Corporate Name

File #: DO NOT SEND CASH This space for use by Secretary of State. Date: Filing Fee: $ (See Note Below) 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 corporation's 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 Officer's 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 name is $25.
Printed by authority of the State of Illinois. June 2006 -- 5M -- C 148.16