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FORMBCA      1.35 
ALLOCATION FACTOR 
INTERROGATORIES
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL  62756
217-782-6961
www.ilsos.gov

This form acts as a supplement to form 
BCA 1.15, Statement of Correction.

__________________________ File #___________________________  Date Reviewed:__________________  Approved: ________
   ________  Submit in duplicate ________   Type or Print clearly in black ink ________ Do not write above this line ________

In accordance with the provisions of the Business Corporation Act of 1983, as amended, the Secretary of State herewith propounds the 
following interrogatories verifying property owned and business transacted as of the applicable date.

                                     PART I: COMPUTATION OF PROPERTY
                                            (Gross Assets — See Notes on Page 3)

                                                 Line reference to                      (a)                         (b)
                The information below                  Schedule L of                  Property                  Property
                     is given as of                  IRS Forms                    wherever                     located in
     ____________________ , _______          1120 & 1120S                              located                     Illinois
              Month & Day             Year

Cash                                                  1                        $ ________________        $ ________________
Trade notes and accounts receivable                     2a                       $ ________________        $ ________________
Inventories                                             3                        $ ________________        $ ________________
U.S. Government obligations                         4                           $ ________________        $ ________________
Tax-exempt securities                              5                           $ ________________        $ ________________
Other current assets                                 6                           $ ________________        $ ________________
Loans to stockholders                              7                           $ ________________        $ ________________
Mortgage and real estate loans                        8                        $ ________________        $ ________________
Other investments                                  9                           $ ________________        $ ________________
Buildings and other depreciable assets              10a                         $ ________________        $ ________________
Depletable assets                                      11a                      $ ________________        $ ________________
Land                                                 12                          $ ________________        $ ________________
Intangible assets                                  13a                          $ ________________        $ ________________
Other assets                                         14                          $ ________________        $ ________________

TOTAL PROPERTY
(Gross Assets)                                                                  $________________        $ ________________

                                                              Page 1
                                  Printed by authority of the State of Illinois. January 2015 — 1 — C 287.7

                                       PART II: COMPUTATION OF BUSINESS TRANSACTED
                                       (Gross receipts — see notes on page 4)

                                                                        Line                     Line                                (c)                                (d)
            The information below                  reference to        reference to                 Gross amount              Gross amount
                   is given as of                           IRS Form            IRS Form                     of business                  of business
 ____________________ , _______             1120                   1120S                        transacted               transacted at or
        Month & Day                    Year                                                                                                 everywhere                  from Illinois

Gross receipts, less returns                              1c                        1c                   $ _______________   $ _______________
Dividends                                                           4                  4b (Sch. K)            $ _______________   $ _______________
Interests                                                             5                  4a (Sch. K)            $ _______________   $ _______________
Gross rents                                                        6                  3A (Sch. K)
                                                                                               and Line 2
                                                                                              (form 8825)            $ _______________   $ _______________
Gross royalties                                                   7                  4c (Sch. K)            $ _______________   $ _______________
Capital gains —                                             Sch. D                 Sch. D
gross sales price                                           [Line 1                 [Line 1
                                                                     col. (d)]                col. (d)]               $ _______________   $ _______________
Sales of business                                       Form 4797          Form 4797
property — gross                                           [Line 2                 [Line 2
sales price                                                  col (d) and          col. (d) and
                                                                     Line 20]               Line 20]               $ _______________   $ _______________
Other income                                                    10                         5                    $ _______________   $ _______________
Non-taxable receipts:
Tax-exempt interest                                     Sch. M-1             Sch. M-1
or dividends                                                   Line 7                 Line 5a               $ _______________   $ _______________
Other                                                                                                                    $ _______________   $ _______________

TOTAL GROSS RECEIPTS
(Gross Amount of Business Transacted)                                                             $      _______________    _______________$

IMPORTANT—These interrogatories must be accompanied by a photocopy of the appropriate pages of the IRS Form 1120
or 1120S containing the line references for all lines completed above. If the corporation is included in a consolidated return,
the appropriate schedules also must be provided.

The undersigned corporation has caused this statement to be signed by a duly authorized officer who affirms, under penal-
ties of perjury, that the facts stated herein are true and correct. All signatures must.                                                    be in BLACK INK

Dated _______________________________ ,  _____    ________________________________________________ 
                                       Month & Day                                   Year                                                Exact Name of Corporation

        ______________________________________
                          Any Authorized Officer’s Signature

        ______________________________________
                                    Name and Title (type or print)
                                                                  Page 2

                 NOTES TO COMPUTATION OF PROPERTY
                                      (Part I)

Total property means gross assets, including all real, personal, tangible and intangible property, without qualification. The
value of gross assets is original cost without reduction for allowances, reserves, depreciation, etc. Total Gross Assets for
this interrogatory should not equal “total assets” on Line 15 of Federal Schedule L (IRS Forms 1120 and 1120S).

1.  Real and personal tangible property, including inventories, buildings, and other depreciable assets, depletable assets,
land, and uninvested cash are located in Illinois if they are physically located in this State.

2.  Trade  notes  and  accounts  receivable  are  located  in  Illinois  if  arising  from  Illinois  sales.  (See  Notes  (2)  and  (3)  of
Computation of Business Transacted.)

3.  Invested cash, U.S. Government obligations, tax-exempt securities, loans to stock holders, mortgage and real estate
loans, and other investments are located in Illinois if the notes, securities or certificates evidencing such investments
are located in Illinois. If there no notes, securities or certificates evidencing such investments, such investments are
located in Illinois if they are administered, managed, or controlled in Illinois.

4.  Intangible property is located in Illinois if arising from the acquisition of a business located in Illinois.

5.  All property not listed above, including other intangible assets, and property patents, trademarks, copyrights, prepaid
expenses, and other miscellaneous assets, are located in Illinois if the property was acquired, produced or primarily
used in Illinois.

6.  Do not show a negative amount on this form. If the entry on the federal return shows a negative amount, insert “0” on
the appropriate line of this document.

                                      Page 3

NOTES TO COMPUTATION OF BUSINESS TRANSACTED
                                                 (Part II)

Total gross receipts from whatever source derived must be allocated to Illinois based on the gross amount of business
transacted by the corporation at or from places of business in Illinois. Gross receipts are not reduced by the cost of goods
sold.  Capital gains are not reduced by basis. Total Gross Receipts should not equal “total income” on Line 11 of IRS Form
1120 or Line 6 of IRS Form 1120S.

1.  Sales of tangible personal property are allocated to Illinois if the sale of the property occurs in Illinois or is shipped from
an Illinois location or the contract evidencing the sale is accepted in Illinois.

2.  Service income, sales, other than the sales of tangible personal property, and other receipts are allocated to Illinois if
the income-producing activity is performed in Illinois is administered, managed, or controlled in Illinois.

3. Income from investments such as dividends and interest (whether taxable or non-taxable) is allocated to Illinois if such
investments are administered, managed, or controlled in Illinois.

4.  Dividends and interest from a subsidiary, if more than 10 percent owned, are allocated to Illinois if the subsidiary trans-
acts business primarily at or from places of business in Illinois.

5.  Gross rents are allocated to Illinois if the property being rented is located in Illinois.

6.  Gross royalties from oil, mineral, or other leases are allocated to Illinois if the leased property is located in Illinois; other
royalty income is allocated to Illinois if the activity giving rise to the payment of the royalty was transacted at or from
locations in Illinois. (See (1) and (2) above.)

7.  Gross sales prices for dispositions of real estate, property and capital assets are allocated to Illinois if the property sold
was located in Illinois at the time of the sale. 

8.  Do not show a negative amount on this form. If the entry on the federal return shows a negative amount, insert “0” on
the appropriate line of this document.

                                                 Page 4