Form C-54.21 - Domestic/foreign Corporation Annual Report General Not For Profit Corporation Act
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1
2JESSE WHITE, SECRETARY OF STATE
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DOMESTIC/FOREIGN CORPORATION
ANNUAL REPORT
GENERAL NOT FOR PROFIT
CORPORATION ACT
Filing Fee: $5
If late, add penalty of $3
________________Do Not Write Above This Line_____________Year: ____________ File #___________________________
1.
Corporation Name __________________________________________________________________________________
2(a).
2(b). Changes
Registered Agent ____________________________
Registered Agent ________________________________
Registered Office ____________________________
Registered Office _________________________________
City, IL, ZIP, County __________________________
City, IL, ZIP, County ______________________________
3(a). Date of Incorporation/Qualification _______________
3(b). State of Incorporation _____________________________
4.)
The names and respective addresses of the corporation's officers and directors are:
NAME
OFFICE
NUMBER & STREET
CITY
STATE
ZIP
President
Secretary
Treasurer
Director
Director
Director
NOTE: List all officers and directors above or list them on an additional sheet: Illinois corporations must have three directors.
5.
The following is a brief statement of the character of the affairs which the corporation is actually conducting:
6.
Is this corporation a Condominium Association as established under the Condominium Property Act?
Yes
No
(Check One)
Is this corporation a Cooperative Housing Corporation defined in Section 216 of the Internal Revenue Code of 1954?
Yes
No
(Check One)
Is this corporation a Homeowner's Association which administers a common-interest community as defined in
subsection (c) of Section 9-102 of the Code of Civil Procedure?
Yes
No
(Check One)
7.
The address, including street and number of the corporation's principal office:
_________________________________________________________________________________________________
(Number and Street)
(City)
(State)
(ZIP Code)
(Please read reverse side of this report before signing below)
8.)
BY ______________________________________________________________
(Authorized Officer's Signature)
(Title)
(Date)
Under the penalty of perjury and as an
authorized officer, I declare that this annual
report, pursuant to provisions of the Gen-
eral Not For Profit Corporation Act, has
been examined by me and is, to the best of
my knowledge and belief, true, correct, and
complete.
ITEM 8 MUST BE SIGNED
C-54.21
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