Form Bca 12.45/13.60 - Application For Reinstatement Domestic/foreign Corporations
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BCA 12.45/13.60
FORM
(rev. Dec. 2003)
APPLICATION FOR REINSTATEMENT
DOMESTIC/FOREIGN CORPORATIONS
BUSINESS CORPORATION ACT
Jesse White, Secretary of State
Department of Business Services
Springfield, IL 62756
217-782-1837 (Foreign)
217-785-5782 or 217-782-5797 (Domestic)
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 Secretary of State.
____________________________________File #__________________________ Filing Fee: $200 Approved:
——————————Submit in duplicate ———————Type or Print clearly in black ink———————Do not write above this line——————————
1.
(a) Corporate name as of date of issuance of Certificate of Dissolution or Revocation:
________________________________________________________________________________
(b) Corporate name if changed (note 2) : ___________________________________________________
________________________________________________________________________________
(c) If a foreign corporation having authority under an assumed corporate name restriction, the assumed
corporate name (note 3) : ____________________________________________________________
________________________________________________________________________________
2.
State of incorporation: __________________________________________________________________
3.
Date Certificate of Dissolution or Revocation issued: __________________________________________
4.
Name and address of the Illinois registered agent and the Illinois registered office, upon reinstatement:
NOTICE! Completion of item #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 #
(P.O. BOX ALONE IS NOT ACCEPTABLE.)
IL
____________________________________________________________
City
ZIP Code
County
5.
This application is accompanied by all delinquent report forms together with the filing fees, franchise taxes,
license fee 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)
By _______________________________________
(Any Authorized Officer’s Signature)
_______________________________________
(Print name and title)
C-89.22 9/04
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