Form Bca-14.01 - Statement Of Election To Establish An Extended Filing Month
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BCA-14.01
FORM
(rev. May 2015)
STATEMENT OF ELECTION TO
ESTABLISH AN EXTENDED
FILING MONTH
Business Corporation Act
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-6961
Payment must be made by check or money
order payable to Secretary of State.
Filing Fee: $25
File #: ___________________________
Approved: ______________________
________ Submit in duplicate ________ Type or Print clearly in black ink ________ Do not write above this line ________
1.
CORPORATE NAME: ________________________________________________________________________
2.
State or Country of Incorporation: ______________________________________________________________
3.
Date Incorporated/Qualified: ___________________________________________________________________
4.
Date of fiscal year end immediately preceding this election: __________________________________________
5.
Extended filing month (See Note 2.): ____________________________________________________________
6.
This Statement of Election is accompanied by an Interim Annual Report, which shall set forth, as of the date of
filing of the statement, all of the information required pursuant to Section 14.05 of the Business Corporation Act
to be included in the annual report, except that the information required by subparagraph (h) of Section 14.05
shall be the amounts represented in this state as disclosed by the preceding annual report, or, if no annual report
is on file, from information contained in the articles of incorporation of a domestic corporation or the application
for authority in the case of a foreign corporation.
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.
Dated: _________________________ , ____________
____________________________________________
Month Day
Year
(Exact Name of Corporation)
by:
_______________________________________
(Any authorized Officer’s signature)
_______________________________________
(Type or Print Name and Title)
IMPORTANT!
FOR A CORPORATION SEEKING TO ESTABLISH AN EXTENDED FILING MONTH, SECTION 14.01 OF THE BUSINESS
CORPORATION ACT REQUIRES THIS DOCUMENT BE FILED PRIOR TO THE FIRST DAY OF THE CORPORATION'S
ANNIVERSARY MONTH.
Printed by authority of the State of Illinois. May 2015 - 1 - C 242.8
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