Fillable FORM BCA 4.10 (rev. Aug. 2014): 217-782-6961 $25 (Illinois Secretary of State)

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FORM BCA 4.10 (rev. Aug. 2014): 217-782-6961 $25 (Illinois Secretary of State)

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1. Name(s) to be Reserved (for a period of 90 days each):
_____________________________________________________________________________________________
Must contain the word “corporation,” “company,” “incorporated” or “limited,” or contain an abbreviation of such words.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2. Proposed Corporate Purpose:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3. Name of Applicant: ______________________________________________________________________________
4. Address of Applicant: ____________________________________________________________________________
_____________________________________________________________________________________________
5. Dated _______________________________ , _____
Month Day Year
______________________________________________
Signature of Applicant
______________________________________________
Name (type or print)
NOTE:
• If the applicant is an individual, this application must be signed by the applicant.
• If the applicant is a corporation, this application must be signed by a duly authorized officer of the corpora-
tion.
• Upon filing of this document, name(s) will be reserved for a period of 90 days.
Printed by authority of the State of Illinois. January 2015 — 1 — C 156.10
FORM BCA 4.10 (rev. Aug. 2014)
APPLICATION FOR RESERVATION OF NAME
Business Corporation Act
Secretary of State
D
epartment of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-9520
217-782-6961
www.cyberdriveillinois.com
Payment must be made by check or money order
payable to Secretary of State.
(
$25 fee to each name reserved.)
Filing fee $ _________________________ File #  ___________________________ Approved: _________________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————
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NOTICE OF TRANSFER
OF
RESERVED NAME
T
he undersigned _____________________________________________________________________ hereby transfers
to _______________________________________________________________________________ the right to use the
name __________________________________________________________________________for corporate purposes
in Illinois. This name was reserved on ____________________________________, __________.
The undersigned affirms, under penalties of perjury, that the facts stated herein are true and correct.
Dated _______________________________ , ______
Month Day Year
by _________________________________________
Signature of Original Applicant
Attested by __________________________________ _________________________________________
Name (type or print)
* As the original applicant, I declare that this document has been examined by me and is to the best of my knowledge and
belief, true, correct and complete.
Name of Original Applicant
Name of Transferee
Month  Day Year
Date:
Filing Fee: $25
Approved:
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FORM BCA 4.10 (rev. Aug. 2014): 217-782-6961 $25 (Illinois Secretary of State)

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Completed 9 August 2021

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