Form Bca 1.15 - Statement Of Correction - Illinois Secretary Of State

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BCA 1.15
FORM
(rev. Dec. 2003)
STATEMENT OF CORRECTION
Business Corporation Act
Jesse White, Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 785-2237
Remit payment in the form of a
check or money order payable
to the Secretary of State.
________________________
File #
Franchise Tax $_______________ Penalty/Interest $_______________ Filing Fee: $50.00 Total $_______________ 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.
Title of document to be corrected:
4.
Date erroneous document was filed by Secretary of State:
5.
Inaccuracy, error or defect:
(Briefly identify the error and explain how it occurred. Use reverse side or add one or more sheets of this size if
necessary.)
6.
Corrected portion(s) of the document in corrected form:
(If there is not sufficient space to cover this point, use reverse side or add one or more sheets of this size.)
7.
The undersigned corporation has caused this statement 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)
by
(Any Authorized Officer's Signature)
C-199.10
(Type or Print Name and Title)

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