Form Nfp-104.25 - Application For Registration, Renewal Or Cancellation Of Foreign Corporation Name Under The General Not For Profit Corporation Act

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APPLICATION FOR REGISTRATION,
NFP-104.25
Form
RENEWAL OR CANCELLATION OF FOREIGN
CORPORATION NAME UNDER THE
(Rev. Jan. 2003)
File #
GENERAL NOT FOR PROFIT CORPORATION ACT
Jesse White
SUBMIT IN DUPLICATE
This space for use by Secretary of State
Secretary of State
Department of Business Services
Springfield, IL 62756
Date
Telephone (217) 782-6961
Filing Fee
$
Remit payment in check or money
Approved:
order, payable to "Secretary of State."
Pursuant to the provisions of “The General Not For Profit Corporation Act of 1986”, the undersigned
corporation hereby submits the following application.
1.
The name of the corporation is ___________________________________________________
____________________________________________________________________________
2.
The State or Country of incorporation is ____________________________________________
3.
Date of incorporation ___________________________________________________________
4.
The affairs which the corporation is conducting are ___________________________________
5.
The post office address of the corporation to which the Secretary of State may mail notices is
____________________________________________________________________________
____________________________________________________________________________
6.
The corporation desires to register its corporate name pursuant to Section 104.25 and it is not
conducting affairs in the State of Illinois at this time.
7.
Attached to this application is a certificate setting forth that the corporation is in good standing
under the laws of the State or County wherein it is organized, executed by the proper officer of the
State or Country wherein it is organized, which certificate shall not be more than ninety (90) days old.
The fee for registration is $50.
8.
Check the appropriate box:
The fee for renewal is $50.
The fee for cancellation is $5.
9.
Such registration shall be effective from the date of filing by the Secretary of State until the first day
of the twelfth month following such date. A renewal shall extend the registration 12 months.
10. The cancellation shall be effective upon filing with the Secretary of State.
The undersigned corporation has caused this application 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)
____________________________________
(Any Authorized Officer’s Signature)
____________________________________
(Type or print name and title)
C-223.5

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