FORM BCA 13.15 (rev. Dec. 2003)
APPLICATION FOR AUTHORITY TO
TRANSACT BUSINESS IN ILLINOIS
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-1832
www.cyberdriveillinois.com
Remit payment in the form of a cashier’s
check, certified check, money order
or an Illinois attorney’s or CPA’s check
payable to the Secretary of State.
SEE NOTE 1 CONCERNING PAYMENT! File #______________________________
Filing Fee: $___________ Franchise Tax: $___________ Penalty/Interest: $___________ Total: $___________ Approved: ________
——————Submit in duplicate—————Type or Print clearly in black ink—————Do not write above this line—————
1. (a) CORPORATE NAME: _________________________________________________________________________________
(Complete item 1 (b) only if the corporate name is not available in this state.)
(b) ASSUMED CORPORATE NAME: ________________________________________________________________________
(By electing this assumed name, the corporation hereby agrees NOT to use its corporate name in the
transaction of business in Illinois. Form BCA 4.15 is attached.)
2.
3. (a) Address of the principal office, wherever located: (b) Address of principal office in Illinois:
(If none, so state)
_______________________________________________ _________________________________________________
_______________________________________________ _________________________________________________
_______________________________________________ _________________________________________________
4. Name and address of the registered agent and registered office in Illinois.
Registered Agent: _____________________________________________________________________________________
Registered Office: _____________________________________________________________________________________
_____________________________________________________________________________________
5. States and countries in which it is admitted or qualified to transact business: (Include state of incorporation)
6. Name and addresses of officers and directors: (If more than 3 directors and/or additional officers, attach list.)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Printed by authority of the State of Illinois. January 2020 - 1 - C 171.18
State or Country
of Incorporation _________________;
Date of
Incorporation _________________;
Period of
Duration ______________________
First Name Middle Initial Last Name
Number Street Suite #
City ZIP County
President
Secretary
Director
Director
Director
Name No. & Street City State ZIP
(A P.O. Box alone
is not acceptable.)
Print
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7. The purpose or purposes for which it was organized which it proposes to pursue in the transaction of business in this
state: (If not sufficient space to cover this point, add one or more sheets of this size)
8. Authorized and issued shares:
Number of Shares Number of Shares
Class Series Par Value Authorized Issued
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
(If more, attach list)
9. Paid-in Capital: $ ________________________________
(“Paid-in Capital” replaces the terms Stated Capital & Paid-in Surplus and is equal to the total of these accounts.)
10. (a) Give an estimate of the total value of all the property* of the
corporation for the following year: $ ________________________________________
(b) Give an estimate of the total value of all the property* of the
corporation for the following year that will be located in Illinois: $ ________________________________________
(c) State the estimated total business of the corporation to be
transacted by it everywhere for the following year: $ ________________________________________
(d) State the estimated annual business of the corporation to be
transacted by it at or from places of business in the State of
Illinois: $ ________________________________________
11. Interrogatories: (Important - this section must be completed.)
(a) Is the corporation transacting business in this state at this time?
(b) If the answer to item 11(a) is yes, state the exact date on which it commenced to transact business in Illinois:
12. This application is accompanied by a certified copy of the articles of incorporation, as amended, duly authenticated, within the last
ninety (90) days, by the proper officer of the state or country wherein the corporation is incorporated.
13. 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. (All signatures must be in BLACK INK.)
Dated ____________________________ , ____________ __________________________________________
__________________________________________
__________________________________________
* PROPERTY as used in this application shall apply to all property of the corporation, real, personal, tangible, intangible, or
mixed without qualifications.
Note 1 Payment in connection with this application must be in the form of a certified check, cashier’s check, Illinois attorney
or CPA’s check or money order made payable to the “Secretary of State.” The minimum fee due upon qualification is $175. Any
additional fees will be billed and must be paid before this application can be filed.
Please see filing periods set forth below regarding the franchise tax exemption amount for each year. (Tax amount minus
exemption amount. If a negative number, no franchise tax due.)
Franchise Tax Liability Exemption Amounts
FILING PERIOD EXEMPTION AMOUNT
1/1/20-12/31/20 Exemption $30.00
1/1/21-12/31/21 Exemption $1,000.00
1/1/22-12/31/22 Exemption $10,000.00
1/1/23-12/31/23 Exemption $100,000.00
1/1/24 and after No Franchise Tax Due.
The minimum total due (franchise tax + filing fee) is $150.
(Month Day) (Year) (Exact Name of Corporation)
(Any Authorized Officer’s Signature)
(Print Name and Title)