Free Application for Authority to Conduct Affairs in Illinois - Illinois

FORM NFP 113.15 (rev. Dec. 2003) APPLICATION FOR AUTHORITY TO CONDUCT AFFAIRS IN ILLINOIS (Foreign Corporations) General Not For Profit Corporation Act Secretary of State Department of Business Services Springfield, IL 62756 217-782-1834 www.cyberdriveillinois.com Remit payment in the form of a cashier's check, certified check, money order or an Illinois attorney's or CPA's check payable to Secretary of State. ____________________________________ File #______________________________

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Filing Fee: $50

Approved: ___________

-------- Submit in duplicate -------- Type or Print clearly in black ink -------- Do not write above this line --------

1. a. Corporate Name: _____________________________________________________________________________ b. Assumed Corporate Name (Complete only if the new corporate name is not available in this state.): ______________________________________________________________________________________________ By electing this assumed name, the Corporation hereby agrees NOT to use its corporate name in the transaction of business in Illinois. Form NFP 104.15 is attached. 2. a. State or Country of Incorporation: _________________________________________________________________ b. Date of Incorporation: __________________________________________________________________________ c. Period of Duration: _____________________________________________________________________________ 3. a. Address of Principal Office, wherever located: _______________________________________________________ ____________________________________________________________________________________________ b. Address of Principal Office in Illinois: ______________________________________________________________ ____________________________________________________________________________________________ 4. Name and Address of Registered Agent and Registered Office in Illinois: Registered Agent: _______________________________________________________________________________
First Name Number City Middle Name Street ZIP Code Last Name Suite # (P.O. Box alone is unacceptable) County

Registered Office: _______________________________________________________________________________ Registered Office _______________________________________________________________________________ 5. States and Countries in which Corporation is admitted or qualified to conduct affairs: __________________________ 6. Names and respective addresses of Corporation's officers and directors:
Street Address City State ZIP

President Secretary Director Director Director If there are additional officers or more than three directors, please attach list.
Printed by authority of the State of Illinois. June 2006 - 5M - C 160.14

7. Purpose(s) for which the Corporation is organized and proposes to pursue in the conduct of affairs in this State: For more space, attach additional sheets of this size.

8. This application must be accompanied by an originally certified copy of the Articles of Incorporation and any amendments or mergers, duly authenticated within the last 90 days by the proper officer of the state or country wherein the corporation is incorporated. 9. 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. All signatures must be in BLACK INK. Dated _______________________________ , _____
Month & Day Any Authorized Officer's Signature Year

________________________________________________
Exact Name of Corporation

______________________________________ ______________________________________
Name and Title (type or print)

A Corporation that is to function as a club, as defined in Section 1-3.24 of the Liquor Control Act of 1934, must insert in its purpose clause a statement that it will comply with the State and local laws and ordinances relating to alcoholic liquors.

Printed by authority of the State of Illinois. June 2006 - 5M - C 160.14