Form Nfp-104.15/104.20 - Application To Adopt, Change Or Cancel An Assumed Corporate Name Of A General Not For Profit Corporation
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1
2NFP-104.15/104.20
File #
JESSE WHITE
(Rev. Jan. 1999)
Secretary of State
State of Illinois
This Space For Use By
Secretary of State
Submit in Duplicate
APPLICATION TO ADOPT,
Date
CHANGE OR CANCEL
Remit payment in check or money
order, payable to "Secretary of
AN ASSUMED CORPORATE NAME
Filing Fee
$
State.
"
OF A GENERAL NOT FOR PROFIT
Approved
CORPORATION
DO NOT SEND CASH!
Pursuant to the provisions of "The General Not For Profit Corporation Act of 1986," the undersigned
corporation hereby submits the following application to adopt, change or cancel an assumed corporate
name. (Strike inapplicable words.)
1.
The true name of the corporation is ________________________________________________
__________________________________________________________________________________
2.
The State or Country of incorporation is _____________________________________________
3.
The date incorporated (if an Illinois corporation) or the date authorized to conduct affairs in Illinois
(if a foreign corporation) is _____________________________ , ________ .
(Month/Day)
(Year)
(Complete No. 4 and No. 5 if adopting or changing an assumed corporate name.)
4.
The corporation intends to adopt and to conduct affairs 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
(Month/Day)
(Year)
the corporation's anniversary month in the next year which is evenly divisible by five.
(Complete No. 6 if changing or cancelling an assumed corporate name.)
6.
The corporation intends to cease conducting affairs under the assumed corporate name of
____________________________________________________________________________
The undersigned corporation has caused this application to be signed by its duly authorized
officers, each of whom affirms, under penalties of perjury, that the facts stated herein are true.
Dated ____________________________ , ________
____________________________________
(Month/Day)
(Year)
(Exact Name of Corporation)
attested by _________________________________
by __________________________________
(Signature of Secretary or Assistant Secretary)
(Signature of President or Vice President)
_________________________________
___________________________________
(Type or Print Name and Title)
(Type or Print Name and Title)
NOTE:
The filing fee to adopt or to change an assumed corporate name is $20 plus $2.50 for each
month or part thereof between the date of filing this application and the date upon which the
corporation may renew its use.
The fee for cancelling an assumed corporate name is $5.
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