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Form Nfp-112.45/113.60 - Application For Reinstatement Of Domestic Or Foreign Corporation Under The General Not For Profit Corporation Act

NFP-112.45/113.60

File #

JESSE WHITE

(Rev. Jan. 1999)

Secretary of State

This Space For Use By

State of Illinois

Secretary of State

Submit in Duplicate

APPLICATION FOR REINSTATEMENT

Date

Payment must be made by

OF DOMESTIC OR FOREIGN

certified check, cashiers' check

CORPORATION UNDER THE

Filing Fee

$ 25

or a money order, payable to

GENERAL NOT FOR PROFIT

"Secretary of State."

CORPORATION ACT

Approved

Pursuant to the provisions of "The General Not For Profit Corporation Act of 1986," the undersigned

corporation hereby applies for reinstatement and submits the following statement.

The name of the corporation, as of the date of issuance of the certificate of dissolution or revocation,

is __________________________________________________________________________

____________________________________________________________________________

and the name of the corporation as changed is ______________________________________

_____________________________________________________________________ (Note 1)

and, if a foreign corporation having a certificate of authority under an assumed corporate name

restriction, the assumed corporate name is __________________________________________

_____________________________________________________________________ (Note 2)

The date that the certificate of dissolution or revocation was issued was ___________, _______

(Month & Day)

(Year)

The name and address of its registered agent and its registered office, upon reinstatement will be:

(Note 3)

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

This application is accompanied by all delinquent report forms together with the filing fees and

penalties required.

The undersigned corporation has caused this application to be signed by its duly authorized officers,

each of whom 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)

attested by __________________________________

by ________________________________

(Signature of Secretary or Assistant Secretary)

(Signature of President or Vice President)

__________________________________

________________________________

(Type or Print Name and Title)

Form Nfp-112.45/113.60 - Application For Reinstatement Of Domestic Or Foreign Corporation Under The General Not For Profit Corporation Act

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