Form Llc-1.20 - Application To Adopt, Change, Cancel Or Renew An Assumed Name - 2015
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Illinois
FILE #
Form
Limited Liability Company Act
This space for use by Secretary of State.
May 2015
Application to Adopt, Change, Cancel
Secretary of State
or Renew an Assumed Name
Department of Business Services
Limited Liability Division
SUBMIT IN DUPLICATE
501 S. Second St., Rm. 351
Springfield, IL 62756
Type or Print Clearly.
217-524-8008
This space for use by Secretary of State.
Payment may be made by check
Filing Fee (See Note):
$
payable to Secretary of State. If
check is returned for any reason this
Approved:
filing will be void.
1. Limited Liability Company Name:____________________________________________________________________
______________________________________________________________________________________________
2. State or Country under the laws of which the company is organized: (check one)
❒ Illinois (domestic)
❒ Foreign (specify): ____________________________
3. Check this box ❒ if it is a Series of the Limited Liability Company that intends to adopt, change, cancel or renew an assumed
name.
Name of Series: ____________________________________________________________________________________
4. TO ADOPT:
The Limited Liability Company or Series intends to adopt and transact business under the
(see note)
assumed name of:_________________________________________________________________
5. TO CHANGE:
(a)
The above-named Limited Liability Company or Series intends to cease transacting business
(see note)
under the assumed name of: ____________________________________________________
(b)
and to commence transacting business under the new assumed name of: _________________
___________________________________________________________________________
6. TO CANCEL:
The above-named Limited Liability Company or Series intends to cease transacting business under
(see note)
the assumed name of: _____________________________________________________________
7. TO RENEW:
The above-named Limited Liability Company or Series intends to renew the assumed name of:
(see note)
________________________________________________________________________________
8. The undersigned affirms, under penalties of perjury, having authority to sign hereto, that this Application to Adopt, Change,
Cancel or Renew an Assumed Name is to the best of my knowledge and belief, true, correct and complete.
Dated: ___________________________, ______________
Month/Day
Year
________________________________________________
Signature
________________________________________________
Name and Title (type or print)
________________________________________________
If applicant is a company or other entity, state name of company
and indicate whether it is a member or manager of the LLC.
Printed by authority of the State of Illinois. August 2015 — 1 — LLC 15.12
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