Print
Reset
Save
NFP 105.15
FORM
NOTICE OF RESIGNATION OF
REGISTERED AGENT
General Not For Profit Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-7808
Payment must be made by check or money order
payable to Secretary of State.
Filing fee $5
File # ___________________________ Approved: _________________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————
1. Corporation Name: ______________________________________________________________________________
2. Name and Address of Registered Agent and Registered Office as they appear on the records of the Office of the
Secretary of State:
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
3. Effective Date of Resignation: _____________________________________________________________________
(Not less than 30 days after its filing by the Secretary of State.)
4. Address of Principal Office of Corporation known to the Registered Agent:
_____________________________________________________________________________________________
Number
Street
Suite # (P.O. Box alone is unacceptable)
_____________________________________________________________________________________________
City
ZIP Code
County
5. A copy of this notice has been sent to the principal office of the corporation at least 10 days prior to the date of its filing
with the Secretary of State.
6. The undersigned affirms, under penalties of perjury, that the facts stated herein are true and correct.
Dated _______________________________ , ______
Month Day
Year
by _________________________________________
by _________________________________________
Signature of Principal Officer
Signature of Registered Agent
by _________________________________________
by _________________________________________
Name (type or print)
Name (type or print)
NOTE: If the registered agent is an individual, this notice must be signed by the registered agent.
If the registered agent is a corporation, this notice must be signed by a principal officer.
Printed by authority of the State of Illinois. January 2015 — 1 — C 346