Form C-54.21 - Domestic/foreign Corporation Annual Report General Not For Profit Corporation Act Page 2

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NOTICE
Under the General Not For Profit Corporation Act, this Annual Report must be properly executed and filed in the Office of the
Secretary of State prior to the first day of the corporation's anniversary month each year. If filed on time, a filing fee of $5.00
only is required by statute. If filed later, a statutory penalty of $3.00 must be added.
This Report must be properly completed and submitted to the Office of the Secretary of State.
Item 1: In the event of a change of corporate name, Articles of Amendment (form NFP 110.30) must be filed in this office.
Item 2: To change the Registered Agent/Office, complete parts (a) and (b) in their entirety. The corporation cannot act as its
own Registered Agent. The Registered Office may be, but need not be, the same as its principal office, but the address of the
Registered Office and the address of the Registered Agent must be the same, must be located in Illinois, and must include
a street number. A P.O. Box may only be used in addition thereto.
*
The information requested must be given as the date of the execution of this report.
*
This report must be signed by an authorized officer of the corporation.
*
If this report is not filed, the corporation, if domestic, is subject to dissolution or if foreign, is subject to having its authority
revoked.
DEFINITIONS
“Anniversary” means that day each year exactly one year or more years after:
(1)The date on the articles of incorporation issued under Section 102.15 of this Act, in the case of a domestic
corporation.
(2)The date on the application for authority issued under Section 113.20 of the Act, in the case of a foreign
corporation.
“Anniversary month” means the month in which the anniversary of the corporation occurs.
NOTICE
QUESTION NUMBER 6 MUST BE ANSWERED!
Failure to answer any question may result in late
penalty, involuntary dissolution or revocation.
RETURN TO:
Department of Business Services
Secretary of State
Springfield, IL 62756
Telephone (217) 782-7808
Make checks payable to Secretary of State

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