FORM NFP 113.15 (rev. Dec. 2003)
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
Remit payment in the form of a cashiers
check, certified check, money order or an
Illinois attorney’s or CPA’s check payable
to Secretary of State.
___________________________________ File #______________________________ Filing Fee: $50 Approved: ___________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————
1. a. Corporate Name: _____________________________________________________________________________
b. 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. Date of Incorporation: __________________________________________________________________________
c. Period of Duration:_____________________________________________________________________________
3. a. Address of Principal Office, wherever located: _______________________________________________________
b. Address of Principal Office in Illinois: ______________________________________________________________
4. Name and Address of Registered Agent and Registered Office in Illinois:
Registered Agent: _______________________________________________________________________________
First Name Middle Name Last Name
Registered Office: _______________________________________________________________________________
Number Street Suite # (P.O. Box alone is unacceptable)
Registered Office _______________________________________________________________________________
City ZIP Code County
5. States and Countries in which Corporation is admitted or qualified to conduct affairs: __________________________
6. Names and respective addresses of Corporation’s officers and directors:
Street Address City State ZIP
If there are additional officers or more than three directors, please attach list.
Printed by authority of the State of Illinois. January 2015 - 1 - C 160.15
7. Purpose(s) for which the Corporation is organized and proposes to pursue in the conduct of affairs in this State:
For more space, attach additional sheets of this size.
8. This application must be accompanied by an originally certified copy of the Articles of Incorporation and any amend-
ments or mergers, duly authenticated within the last 90 days by the proper officer of the state or country wherein the
corporation is incorporated.
9. 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)
A Corporation that is to function as a club, as defined in Section 1-3.24 of the Liquor Control Act of 1934, must insert in its
purpose clause a statement that it will comply with the State and local laws and ordinances relating to alcoholic