Form Nfp 113.40 - Application For Amended Authority To Conduct Affairs

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NFP 113.40
FORM
(rev. Dec. 2003)
APPLICATION FOR AMENDED
AUTHORITY TO CONDUCT AFFAIRS
IN ILLINOIS (Foreign Corporations)
General Not For Profit Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-6961
Remit payment in the form of a
check or money order payable
to Secretary of State.
Filing Fee: $25
____________________________________ File #_____________________________
Approved: ___________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————
1. Corporate Name: ________________________________________________________________________________
If a Change of Name is being Reported, the New Corporate Name: ________________________________________
Assumed Corporate Name (Complete only if the new corporate name is not available in this state.):
______________________________________________________________________________________________
By electing this assumed name, the Corporation hereby agrees NOT to use its corporate name in the transaction of
business in Illinois. Form NFP 104.15 is attached.
2. a. State or Country of Incorporation: _________________________________________________________________
b. If changed, Period of Duration: ___________________________________________________________________
3. If changed, Purpose(s) for which it is organized and proposes to pursue in the conduct of affairs in this State.
For more space, use reverse side or attach additional sheets of this size.
4. This application is accompanied by a copy of the Articles of Amendment to the Articles of Incorporation, if any, as evi-
dence of any change of name, duration or purpose reported herein, such copy being duly authenticated by the proper
officer of the State or Country wherein the corporation is incorporated, which certification is not more than 90 days old.
5. The undersigned Corporation has caused this statement to be signed by a duly authorized officer who affirms, under
penalties of perjury, that the facts stated herein are true and correct. All signatures must be in BLACK INK.
Dated _______________________________ , _____
________________________________________________
Month Day
Year
Exact Name of Corporation
______________________________________
Any Authorized Officer’s Signature
______________________________________
Name and Title (type or print)
Printed by authority of the State of Illinois. January 2015 — 1M — C 218.9

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