Form Nfp 101.15 - Statement Of Correction General Not For Profit Corporation Act
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NFP 101.15
FORM
(rev. Dec. 2003)
STATEMENT OF CORRECTION
General Not For Profit 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 #_________________________________
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.
Title of document to be corrected: _________________________________________________________
4.
Date erroneous document was filed by the Secretary of State:
________________________________
5.
Briefly identify the inaccuracy, error or defect to be corrected:
6.
Corrected portion(s) of the document in like format: If there is not sufficient space, 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)
_______________________________
(Any authorized officer’s signature)
_______________________________
(Print name and title)
C-224.7
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