Get IL BCA-4.15/4.20 2003

Print Application to Adopt Change or Cancel an Assumed Corporate Name Form BCA-4. 15/4. 20 Rev. Jan. 2003 Secretary of State Department of Business Services Springfield IL 62756 217-782-9520 www. cyberdriveillinois. com Reset File DO NOT SEND CASH This space for use by Date Filing Fee See Note Below Remit payment in the form of a check or money order payable to Approved 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. 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 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. cyberdriveillinois. com Reset File DO NOT SEND CASH This space for use by Date Filing Fee See Note Below Remit payment in the form of a check or money order payable to Approved 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. 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. 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. 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. 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. .