Fillable FORM BCA 5.10/5.20 (rev. Dec. 2003): STATEMENT OF (Illinois Secretary of State)

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FORM BCA 5.10/5.20 (rev. Dec. 2003): STATEMENT OF (Illinois Secretary of State)

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BROWSE ILLINOIS SECRETARY OF STATE FORMS

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FORM BCA 5.10/5.20 (rev. Dec. 2003)
STATEMENT OF CHANGE OF
REGISTERED AGENT AND/OR
REGISTERED OFFICE
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-7808
www.cyberdriveillinois.com
Remit payment in the form of a
check or money order payable
to Secretary of State.
Submit in duplicate ___________________ File #_____________________________ Filing Fee: $25 Approved: _____________
1. Corporate name: _______________________________________________________________________________
2. State or country of incorporation: ___________________________________________________________________
3. Name and address of Registered Agent and registered office as they appear on the records of the Office of the Secretary
of State (before change):
Registered Agent: _______________________________________________________________________________
First Name Middle Name Last Name
Registered office: _______________________________________________________________________________
Number Street Suite # (P.O. Box alone is unacceptable)
`
City ZIP County
4. Name and address of Registered Agent and registered office shall be (after all changes herein reported):
Registered Agent: _______________________________________________________________________________
First Name Middle Name Last Name
Registered office: _______________________________________________________________________________
Number Street Suite # (P.O. Box alone is unacceptable)
Registered Office _______________________________________________________________________________
City ZIP County
5. The address of the registered office and the address of the business office of the registered agent, as changed, will be identical.
6. The above change was authorized by: (“X” one box only)
a. q Resolution duly adopted by the board of directors. (See Note 4 on reverse.)
b. q Action of the registered agent. (See Note 5 on reverse.)
7. The undersigned under penalties of perjury, affirms that the facts stated herein are true and correct.
Dated: _______________________________ , _____ ________________________________________________
Month Day Year Exact name of corporation
______________________________________
Signature of Registered Agent of record or authorized officer
______________________________________
Name and title (type or print)
_______________________________________________________
If applicant is signing for a company or other entity, state name of company or entity.
Printed by authority of the State of Illinois. June 2021 — 1 — C 135.25
IL
IL
Reset
NOTES
1. The registered office may, but need not be, the same as the principal office of the corporation; however, the registered
office and the office address of the registered agent must be the same.
2. The registered office must include a street or road address (P.O. Box alone is unacceptable).
3. A corporation cannot act as its own registered agent.
4. Any change of registered agent must be by resolution adopted by the board of directors. This statement must be signed
by a duly authorized officer.
5. The registered agent may report a change of the registered office of the corporation for which he/she is a registered
agent. When the agent reports such a change, this statement must be signed by the registered agent. If a corporation is
acting as the registered agent, a duly authorized officer of such corporation must sign this statement.
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FORM BCA 5.105.20 (rev. Dec. 2003): STATEMENT OF (Illinois Secretary of State)

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Completed 9 August 2021

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