Form Bca 14.30 - Cumulative Report Of Changes In Issues Shares And Paid-In Capital 2014
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BCA 14.30
FORM
(rev. Dec. 2014)
CUMULATIVE REPORT OF CHANGES IN
ISSUED SHARES AND PAID-IN CAPITAL
Business Corporation Act
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-1837
File #: _____________________
Payment must be made by check or money
order payable to Secretary of State.
Franchise Tax: $ ________________ Penalty/Interest: $ _______________ Filing fee: $5 Total $ ________________ Approved: __________
________ Type or Print clearly in black ink ________ Do not write above this line ________
1. Corporate Name: ________________________________________________________________________________
2. State or Country of Incorporation: ___________________________________________________________________
3. Authorized and Issued Shares as last reported (In any document other than an annual report.):
Class
Series
Par Value
Number Authorized
Number Issued
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
4. Paid-in Capital as last reported (In any document other than an annual report.): $ _____________________________
5. Current Reporting Period Transactions (See Note 1 on back.):
• List the total issuances and exchanges of shares by class not previously reported to the Secretary of State. Also,
give the value of the entire consideration received (less expenses paid or incurred in connection with such issuances)
and added or transferred to paid-in capital for or on account of such shares.
• List the total amount added or transferred to paid-in capital without the issuance of shares (contributions).
• List the total of all cancellations of shares by class not previously reported to the Secretary of State and the cost to
paid-in capital for acquiring such shares.
• List the total amount subtracted from paid-in capital without a cancellation of shares, but as permitted by Section 9.20
of the Illinois Business Corporation Act (reductions).
Class of
Number of
Consideration
________________________________________________________________________________________________
Shares
Series
Par Value
Shares
Received/Cost
Issuance or
$
Contributions:
$
$
$
Cancellations
$ ( )
or Reductions:
$ ( )
(State reason for reduction if no shares were cancelled. See Note 6 on back.)
$ ( )
Cumulative Change (Enter on line 6a below. See Note 2 on back.):
$
6. Franchise Tax and Fees (No additional franchise tax is due when cumulative change is negative amount.):
a. Cumulative Change ......................................................................
a.
b. Applicable Allocation Factor (See Note 3 on back.) .....................
b.
c. Taxable Illinois Capital (Multiply line a by line b.) .........................
c.
d. Multiply line c by .0015 (Round to nearest cent.) .........................
d.
e. Additional Franchise Tax (Enter amount from line d.) .........................................................
e.
f. If Cumulative Report is late, multiply line e by .10 (penalty) ...............................................
f.
g. If Additional Franchise Tax is late, multiply line e by .02 for each month late
or part thereof (interest) (minimum $1)................................................................................
g.
h. FILING FEE ($5)..................................................................................................................
h.
5.00
i. Total Amount Due (Add line e + line f + line g + line h.)......................................................
i.
COMPLETE BOTH SIDES OF THIS REPORT.
Printed by authority of the State of Illinois. January 2015 - 1 - C 284.13
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