Form Bca 13.15 - Application For Authority To Transact Business In Illinois
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BCA 13.15
FORM
(rev. Dec. 2003)
APPLICATION FOR AUTHORITY TO
TRANSACT BUSINESS IN ILLINOIS
Business Corporation Act
Jesse White, Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 782-1834
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 the Secretary of State.
File #
SEE NOTE 1 CONCERNING PAYMENT!
Filing Fee $_____________ Franchise Tax $_____________ Penalty/Interest $_____________ Total $_____________ Approved:
——————————Submit in duplicate ———————Type or Print clearly in black ink———————Do not write above this line——————————
1.
(a)
CORPORATE NAME: __________________________________________________________________
(Complete item 1 (b) only if the corporate name is not available in this state.)
(b)
ASSUMED CORPORATE NAME: ____________________________________________________
(By electing this assumed name, the corporation hereby agrees NOT to use its corporate name in the
transaction of business in Illinois. Form BCA 4.15 is attached.)
2.
State or Country
Date of
Period of
of Incorporation _________________;
Incorporation _________________;
Duration _________________
3.
(a)
Address of the principal office, wherever located:
(b)
Address of principal office in Illinois:
(If none, so state)
___________________________________________
_____________________________________________
___________________________________________
_____________________________________________
___________________________________________
_____________________________________________
4.
Name and address of the registered agent and registered office in Illinois.
Registered Agent: _____________________________________________________________________________
First Name
Middle Initial
Last name
Registered Office: _____________________________________________________________________________
(A P.O. Box alone
Number
Street
Suite #
is not acceptable.)
_____________________________________________________________________________
City
ZIP Code
County
5.
States and countries in which it is admitted or qualified to transact business: (Include state of incorporation)
6.
Name and addresses of officers and directors: (If more than 3 directors and/or additional officers, attach list.)
Name
No. & Street
City
State
ZIP
____________________________________________________________________________________________
President
____________________________________________________________________________________________
Secretary
____________________________________________________________________________________________
Director
____________________________________________________________________________________________
Director
____________________________________________________________________________________________
Director
____________________________________________________________________________________________
C-171.15
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