Statement Of Amendment Page 2

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UPA-1001(h)/1102(g)
5. Effective date of this amendment:
❏ Upon filing by the Secretary of State
❏ Deferred effective date (not to exceed 30 days after the file date): _______________________________
Month, Day, Year
6. The undersigned declares, under the penalty of perjury, under the laws of the State of Illinois, that the
foregoing is true, correct and complete.
Executed on the _______________ of _________________ , ____________ by a partner.
Day
Month
Year
__________________________________________________
________________________________________________
Signature
Street Address
1.
__________________________________________________
2.
________________________________________________
Name (type or print)
City, State, Zip
1.
__________________________________________________
2.
Name if a Corporation or other Entity
For additional space, continue in the same format on a plain white 8.5x11” sheet of paper.

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