Form Nfp-101.15 - Statement Of Correction Under The General Not For Profit Corporation Act

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STATEMENT OF CORRECTION
NFP-101.15
File #
Form
UNDER THE
GENERAL NOT FOR PROFIT
CORPORATION ACT
(Rev. Jan. 2003)
Submit in Duplicate
This space for use by Secretary of State
Jesse White
Date
Secretary of State
Department of Business Services
Springfield, IL 62756
Filing Fee
$ 25.00
Telephone: (217) 782-6961
Remit payment by check or money
Approved:
order payable to “Secretary of State”.
1.
Corporate name: ______________________________________________________________________
2.
State or Country of Incorporation: _________________________________________________________
3.
Title of document to be corrected: _________________________________________________________
4.
Date erroneous document was filed by the Secretary of State:
________________________________
5.
Briefly identify the inaccuracy, error or defect to be corrected:
6.
Corrected portion(s) of the document in like format: If there is not sufficient space, add one or more sheets
of this size.
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. (All signatures must be in BLACK INK.)
Dated ____________________________________
____________________________________________
(Month, Day & Year)
(Exact Name of Corporation)
_______________________________
(Any authorized officer’s signature)
_______________________________
(Print name and title)
C-224.6

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