Form Nfp-105.25 - Affidavit Of Compliance For Service On Secretary Of State - Under The General Not For Profit Corporation Act
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NFP-105.25
FORM
(rev. Dec. 2014)
AFFIDAVIT OF COMPLIANCE FOR
SERVICE ON SECRETARY OF STATE
Under the General Not For Profit Corporation Act
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-6961
Payment must be made by check or money
order payable to Secretary of State.
Filing Fee: $10
File #: ___________________________
Approved: ______________________
________ Submit in duplicate ________ Type or Print clearly in black ink ________ Do not write above this line ________
1.
Title and Number of Case:
________________________________
first named plaintiff
Number: _______________
V.
________________________________
first named defendant
2.
Name of corporation being served: ____________________________________________________________
3.
Title of court in which an action, suit or proceeding has been commenced: _____________________________
4.
Title of instrument being served: ______________________________________________________________
5.
Basis for service on the Secretary of State: (check and complete appropriate box)
a. ❏
The corporation’s registered agent cannot with reasonable diligence be found at the registered office of
record in Illinois.
b. ❏
The corporation has failed to appoint and maintain a registered agent in Illinois.
c. ❏
The corporation was dissolved on ___________________________ , _________ ; the conditions
Month Day
Year
of paragraphs (a) or (b) above exist; and the action, suit or proceeding has been instituted against or
has affected the corporation within five (5) years thereafter.
d. ❏
The corporation’s authority to transact business in Illinois has been withdrawn/revoked (circle one) on
________________________ , ___________ .
Month Day
Year
e. ❏
The corporation is a foreign corporation that has conducted affair in Illinois without procuring authority,
contrary to the provisions of the Business Corporation Act of 1983.
6.
Address to which the undersigned will cause a copy of the attached process, notice or demand to be sent by certified
or registered mail:__________________________________________________________________________
7.
The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete.
_________________________________________
_____________________________
___________
Month Day
Year
Signature of Affiant
__________________________________________
( )
Telephone Number
Return to (please type or print clearly):
____________________________________
Name
____________________________________
Street
____________________________________
City/Town
State
Zip
Printed by authority of the State of Illinois. January 2015 — 1 — C 221.5
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