Free Notice of Resignation of Registered Agent - Illinois

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Form BCA-5.15 NFP 105.15
(Rev. Jan. 2003)
This space for use by Secretary of State.

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Notice of Resignation of Registered Agent

File #: SUBMIT ONE ORIGINAL
This space for use by Secretary of State.

Secretary of State Department of Business Services 501 S. Second St., Rm. 328 Springfield, IL 62756 217-782-7808 www.cyberdriveillinois.com

Date: Filing Fee: $5
Payment must be made by check or money order payable to Secretary of State.

Approved:

1. Corporation Name: ______________________________________________________________________________ 2. Name and Address of Registered Agent and Registered Office as they appear on the records of the Office of the Secretary of State: Registered Agent: _______________________________________________________________________________
First Name Middle Name Last Name

Registered Office: _______________________________________________________________________________
Number Street Suite # (P.O. Box alone is unacceptable)

Registered Office _______________________________________________________________________________
City ZIP Code County

3. Effective Date of Resignation: _____________________________________________________________________ (Not less than 30 days after its filing by the Secretary of State.) 4. Address of Principal Office of Corporation known to the Registered Agent: _____________________________________________________________________________________________
Number Street Suite # (P.O. Box alone is unacceptable)

_____________________________________________________________________________________________
City ZIP Code County

5. A copy of this notice has been sent to the principal office of the corporation at least 10 days prior to the date of its filing with the Secretary of State. 6. The undersigned affirms, under penalties of perjury, that the facts stated herein are true and correct.

Dated _______________________________ , ______
Month & Day Year

by _________________________________________
Signature of Principal Officer

by _________________________________________
Signature of Registered Agent

by _________________________________________
Name (type or print)

by _________________________________________
Name (type or print)

NOTE: If the registered agent is an individual, this notice must be signed by the registered agent. If the registered agent is a corporation, this notice must be signed by a principal officer.

Printed by authority of the State of Illinois. July 2008 -- 1M -- C 200.9