Fo
rm BCA-4.15/4.20 (Rev. Aug. 2014)
APPLICATION TO ADOPT, CHANGE OR
CANCEL AN ASSUMED CORPORATE NAME
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-9520
217-782-6961
www.ilsos.gov
Payment must be made by check or money order
payable to Secretary of State.
1. Corporate Name: ________________________________________________________________________________
2. State or Country of Incorporation: ___________________________________________________________________
3. Date Incorporated (if an Illinois corporation) or Date Authorized to Transact Business in Illinois (if a foreign corporation):
_________________________________________________.
Month Day Year
Complete No. 4 and No. 5 if adopting or changing an assumed corporate name.
4. Corporation intends to adopt and to transact business under the assumed corporate name of:
______________________________________________________________________________________________
5. The right to use the assumed corporate name shall be effective from the date this application is filed by the Secretary
of State until _______________________________________________, the first day of the corporation’s anniversary
month in the next year evenly divisible by five.
Complete No. 6 if changing or cancelling an assumed corporate name.
6. Corporation intends to cease transacting business under the assumed corporate name of:
______________________________________________________________________________________________
7. 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.
Dated ______________________________________ ________________________________________________
Month Day Year Exact Name of Corporation
______________________________________
Any Authorized Officer’s Signature
______________________________________
Name and Title (type or print)
NOTE: The filing fee to adopt an assumed corporate name is $150 if the current year ends with a 0 or 5; $120 if the current
year ends with a 1 or 6; $90 if the current year ends with a 2 or 7; $60 if the current year ends with a 3 or 8; or $30
if the current year ends with a 4 or 9.
The fee for cancelling an assumed corporate name is $5.
The fee to change an assumed name is $25.
Printed by authority of the State of Illinois. January 2015 — 1 — C 148.18
Month Day Year
Filing fee $ _________________________ File # ___________________________ Approved: _________________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————
