Form Nfp-113.15 -Application For Certificate Of Authority To Conduct Affairs In Illinois Under The General Not For Profit Corporation Act - State Of Illinois
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1
2NFP-113.15
JESSE WHITE
File #
(Rev. Jan. 1999)
Secretary of State • State of Illinois
This Space For Use By
APPLICATION FOR CERTIFICATE
SUBMIT IN DUPLICATE
Secretary of State
OF AUTHORITY TO CONDUCT
Payment must be made by certified
Date
AFFAIRS IN ILLINOIS
check, cashiers' check or a money
under the
order, Illinois attorney's check, Illinois
GENERAL NOT FOR PROFIT
C.P.A.'s check, payable to
Filing Fee
$ 50
CORPORATION ACT
"Secretary of State."
Telephone (217)782-3647
Approved
Pursuant to the provisions of "The General Not For Profit Corporation Act of 1986," the undersigned
corporation hereby applies for a certificate of authority to conduct affairs in the State of Illinois and
submits the following statement.
1.
(a) CORPORATE NAME: _______________________________________________________
____________________________________________________________________________
(b) ASSUMED CORPORATE NAME: ______________________________________________
____________________________________________________________________________
(By electing this assumed name, the corporation hereby agrees NOT to use its corporate name in the
conducting of affairs in Illinois. Form NFP 104.15 is attached.)
State or Country
Date of
2.
of Incorporation ____________ ; Incorporation __________ ; Period of Duration __________
3.
The address of its principal office, wherever located, is ________________________________
____________________________________________________________________________
and the address of its principal office in Illinois is _____________________________________
____________________________________________________________________________
4.
The name and address of its registered agent and its registered office in Illinois are:
Registered Agent
____________________________________________________________
First Name
Middle Name
Last Name
Registered Office
____________________________________________________________
Number
Street
Suite # (A P.O. box alone is not acceptable)
____________________________________________________________
City
ZIP Code
County
____________________________________________________________
5.
The states and countries in which it is admitted or qualified to conduct affairs are:
6.
The names and respective residential addresses of its officers and directors are:
No. & Street
City
State
ZIP
President
Secretary
Director
Director
Director
If more than 3, attach list
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