Form Nfp 104.10 Application For Reservation Of Name - Illinois Secretary Of State
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NFP 104.10
FORM
(rev. Aug. 2014)
APPLICATION FOR RESERVATION OF NAME
Under the General Not For Profit Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-9520
217-782-6961
Payment must be made by check or money
order payable to Secretary of State.
($25 fee to each name reserved.)
File # ___________________________ Approved: _________________
———— Type or Print clearly in black ink ———— Do not write above this line ————
Pursuant to the provisions of "The General Not For Profit Corporation Act of 1986," the undersigned hereby
submits the following Application for Reservation of Name.
1.
The following name or names shall be reserved for a period of 90 days each:
________________________________________________________________________________
(May contain the word "corporation", "incorporated", or "limited", or may contain an abbreviation of one such word)
________________________________________________________________________________
2.
A brief summary of the purpose intended to be conducted by the corporation is:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
3.
Name of applicant: __________________________________________________________________
4.
Address of applicant: ________________________________________________________________
________________________________________________________________________________
Date: ________________________________
____________________________________
______________________________________
Signature of Applicant
____________________________________
______________________________________
NOTE: If the applicant is an individual, it is to be signed by the applicant.
If the applicant is a corporation, it is to be signed by the corporation's president or vice-president
and verified by him/her and attested to by the secretary or an assistant secretary.
Printed by authority of the State of Illinois. January 2015– 1 – C 140.12
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