Form Bca 5.10/5.20 - Statement Of Change Of Registered Agent And/or Registered Office
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2BCA 5.10/5.20
FORM
(rev. Dec. 2003)
STATEMENT OF CHANGE OF
REGISTERED AGENT AND/OR
REGISTERED OFFICE
Business Corporation Act
Jesse White, Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 782-3647
Remit payment in the form of a
check or money order payable
to the Secretary of State.
_____________________________________ File #_________________________________
Filing Fee: $25.00
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.
Name and address of the registered agent and registered office as they appear on the records of the office
of the Secretary of State (before change):
Registered Agent ________________________________________________________________
First Name
Middle Name
Last Name
Registered Office ________________________________________________________________
Number
Street
Suite No. (A P.O. Box alone is not acceptable)
________________________________________________________________
City
ZIP Code
County
4.
Name and address of the registered agent and registered office shall be (after all changes herein reported):
Registered Agent ________________________________________________________________
First Name
Middle Name
Last Name
Registered Office ________________________________________________________________
Number
Street
Suite No. (A P.O. Box alone is not acceptable)
________________________________________________________________
City
ZIP Code
County
5.
The address of the registered office and the address of the business office of the registered agent, as changed,
will be identical.
6.
The above change was authorized by: (“X” one box only)
❑
a.
By resolution duly adopted by the board of directors.
(Note 5)
❑
b.
By action of the registered agent.
(Note 6)
SEE REVERSE SIDE FOR SIGNATURES(S).
C-135.17
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