Form Nfp-113.40 - Application For Amended Authority To Conduct Affairs In Illinois Under The General Not For Profit Corporation Act

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APPLICATION FOR AMENDED AUTHORITY TO
NFP-113.40
File #
CONDUCT AFFAIRS IN ILLINOIS
Form
UNDER THE
GENERAL NOT FOR PROFIT
CORPORATION ACT
(Rev. Jan. 2003)
Submit in Duplicate
Jesse White
This space for use by Secretary of State
Date
Secretary of State
Department of Business Services
Springfield, IL 62756
Filing Fee
$ 25.00
Telephone: (217) 782-6961
Remit payment by 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 applies for an amended certificate of authority to conduct affairs in the State of Illinois
and submits the following statement.
1.
The name of the corporation is ___________________________________________________
____________________________________________________________________________
and, if a change of name is being reported, the new corporate name is ____________________
____________________________________________________________________________
*(Complete only if the new corporate name is not available in this state.)
ASSUMED CORPORATE NAME: _________________________________________________
(By electing this assumed name, the corporation hereby agrees NOT to use its corporate name in
the transaction of business in Illinois. Form NFP 104.15 is attached.)
2.
(a) State or Country of Incorporation: _____________________________________________
(b) If changed, Period of Duration: _______________________________________________
3.
If changed, Purpose of Purposes for which it is organized and which it proposes to pursue in the
conduct of affairs in this state are:
(If not sufficient space to cover this point, use reverse side or add one or more sheets of this size.)
4.
This application is accompanied by a copy of the articles of Amendment to the Articles of
Incorporation, if any, as evidence of any change of name, duration or purpose reported herein, such
copy being duly authenticated by the proper officer of the State or Country wherein the corporation
is incorporated, which certification is not more than ninety (90) days old.
5.
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. (All signatures must be
in BLACK INK.)
Dated ________________________ , _________ _______________________________________
(Month & Day)
(Year)
(Exact Name of Corporation)
______________________________
(Any authorized officer's signature)
______________________________
C-218.6
(Type or Print Name and Title)

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