Fillable FORM BCA 12.45/13.6 (rev. Dec. 2003): APPLICATION FOR (Illinois Secretary of State)

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FORM BCA 12.45/13.6 (rev. Dec. 2003): APPLICATION FOR (Illinois Secretary of State)

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FORM BCA 12.45/13.6 (rev. Dec. 2003)
APPLICATION FOR REINSTATEMENT
DOMESTIC/FOREIGN CORPORATIONS
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-1837 (foreign)
217-785-5782 or 217-782-5797 (domestic)
www.cyberdriveillinois.com
Remit payment in the form of a cashier’s
check, certified check, money order,
Illinois attorney’s check payable to
Secretary of State.
See notes on back.
____________________________________ File #_____________________________ Filing Fee: $200 Approved: ___________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————
1. a. Corporate Name as of date of issuance of Certificate of Dissolution or Revocation:
____________________________________________________________________________________________
b. Corporate Name if changed: (See Note 2.)
____________________________________________________________________________________________
c. If a foreign corporation having authority under an assumed corporate name restriction, the Assumed Corporate Name:
(See Note 3.) __________________________________________________________________________________
_____________________________________________________________________________________________
2. State of Incorporation: ____________________________________________________________________________
3. Date Certificate of Dissolution or Revocation issued: _____________________________________________________
4. Name and Address of Illinois Registered Agent and the Illinois Registered Office upon reinstatement:
NOTICE: Completion of Item 4 does not constitute a registered agent or office change. (See Note 4.)
Registered Agent ________________________________________________________________________________
First Name Middle Name Last Name
Registered Office ________________________________________________________________________________
Number Street Suite # (P.O. Box alone is unacceptable)
________________________________________________________________________________
City ZIP Code County
5. This application is accompanied by all delinquent report forms together with the filing fees, franchise taxes, license fee
and penalties required. (See Note 1.)
6. The undersigned corporation has caused this application 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. April 2015 — 2.5M — C 89.25
IL
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NOTES
1. All fees in connection with the reinstatement must be in the form of a certified check, cashier’s check, Illinois attorney’s
check, CPA’s check or money order payable to Secretary of State. This includes all filing fees, franchise taxes, penalties
and interest.
2. If the corporate name the corporation had at the time of dissolution or revocation is not available for use at the time of
reinstatement, the corporation shall set forth the new name by which it will hereafter be known. A change of corporate
name also must be properly effected in accordance with the provisions of the Business Corporation Act of 1983. For do-
mestic corporations, Articles of Amendment must be filed, pursuant to Section 10.30. For foreign corporations, if the
name has been changed, an Application for Amended Authority (Form BCA 13.40), together with a certified copy of the
amendment, must be filed pursuant to Section 13.40.
3. This item must be completed if either the foreign corporation’s true name was not available at the time of qualification or
the foreign corporation’s true name is now not available at the time of reinstatement, If the foreign corporation’s true
name is no longer available at the time of reinstatement, Forms BCA 13.40 and BCA 4.15 must accompany the other
documents pertaining to the reinstatement. If the renewal date for the assumed name is prior to the date of signing in
Item 6, an assumed name renewal statement must accompany the reinstatement application.
4. If either or both the registered agent or the registered office of the corporation has changed since the time of dissolution
or revocation, the corporation shall properly report such a change on Form BCA-5.10.
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FORM BCA 12.4513.6 (rev. Dec. 2003): APPLICATION FOR (Illinois Secretary of State)

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Completed 28 August 2020

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