Form Nfp 112.45/113.60 - Application For Reinstatement Domestic Foreign Corporations - Illinois Secretary Of State

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NFP 112.45/113.60
FORM
(rev. Dec. 2003)
APPLICATION FOR REINSTATEMENT
DOMESTIC/FOREIGN CORPORATIONS
General Not for Profit Corporation Act
Jesse White, Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 782-5797
(217) 785-5782
Remit payment in the form of a cashier’s
check, certified check, money order
or an Illinois attorney’s or CPA’s check
payable to the Secretary of State.
DO NOT SEND CASH!
_____________________________________ File #_________________________________
Filing Fee: $25.00
Approved:
——————————Submit in duplicate ———————Type or Print clearly in black ink———————Do not write above this line——————————
1.
(a) Corporate name as of the date of issuance of the certificate of dissolution or revocation:
_________________________________________________________________________________
(b) Corporate name if changed (Note 2): ___________________________________________________
(c) If a foreign corporation having authority to conduct affairs under an assumed corporate name restriction,
the assumed corporate name (Note 3):
_________________________________________________________________________________
2.
State of Incorporation: ___________________________________
3.
Date that the certificate of dissolution or revocation was issued: _________________________________
4.
Name and address of the Illinois registered agent and the Illinois registered office, upon reinstatement:
NOTICE! Completion of Article 4 does not constitute a registered agent or office change. (Note 4)
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.
This application is accompanied by all delinquent reports together with the filing fees and penalties required.
(Note 1)
6.
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)
______________________________________________
(Print name and title)
C-219.9

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