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FORM   BCA 13.15 (rev. July 2021) 
APPLICATION FOR AUTHORITY TO 
TRANSACT BUSINESS IN ILLINOIS 
Business Corporation Act 
Secretary of State 
Department of Business Services 
501 S. Second St., Rm. 350 
Springfield, IL  62756 
217-782-1834
www.ilsos.gov
Remit payment in the form of a cashier’s 
check, certified check, money order 
or an Illinois attorney’s or CPA’s check  
payable to the Secretary of State. 

SEE NOTE 1 CONCERNING PAYMENT.              File #______________________________     

Filing Fee: $___________ Franchise Tax: $___________ Penalty/Interest: $___________ Total: $___________ Approved: ________ 
——————Submit in duplicate —————Type or print clearly in black ink—————Do not write above this line————— 
1. (a) CORPORATE NAME:  _________________________________________________________________________________
   (Complete item 1 (b) only if the corporate name is not available in this state.)
   (b) ASSUMED CORPORATE NAME:  ________________________________________________________________________
       (By electing this assumed name, the corporation hereby agrees NOT to use its corporate name in the
       transaction of business in Illinois. Form BCA 4.15 is attached.)

2.   State or Country                                Date of                                               Period of  
     of Incorporation _________________;             Incorporation _________________;                      Duration  ______________________

3. (a) Address of the principal office, wherever located:              (b)         Address of principal office in Illinois:
                                                                                   (If none, so state)
   _______________________________________________                     _________________________________________________ 
   _______________________________________________                     _________________________________________________ 
   _______________________________________________                     _________________________________________________ 

4. Name and address of the registered agent and registered office in Illinois.
   Registered Agent:     _____________________________________________________________________________________ 
                            First Name                            Middle Initial                                     Last Name 
   Registered Office:    _____________________________________________________________________________________ 
                                   Number                              Street                                 Suite #          (A P.O. Box alone 
                                                                                                                               is not acceptable.)
                         _____________________________________________________________________________________IL     
                                     City                                          ZIP                                           County

5. States and countries in which it is admitted or qualified to transact business: (Include state of incorporation.)

6. Name and addresses of officers and directors: (If more than 3 directors and/or additional officers, attach list.)
                       Name                          No. & Street                      City                   State               ZIP

   President ________________________________________________________________________________________________________ 

   Secretary ________________________________________________________________________________________________________ 
   Director ________________________________________________________________________________________________________ 
   Director ________________________________________________________________________________________________________ 
   Director________________________________________________________________________________________________________ 

                                    Printed by authority of the State of Illinois. July 2021 - 1 - C 171.20

7. The purpose or purposes for which it was organized which it proposes to pursue in the transaction of business in this
state: (If not sufficient space to cover this point, add one or more sheets of this size.)

8. Authorized and issued shares:
                                                                       Number of Shares    Number of Shares 
Class             Series                    Par Value                           Authorized                    Issued 
__________________________________________________________________________________________________________ 
__________________________________________________________________________________________________________ 
__________________________________________________________________________________________________________ 
__________________________________________________________________________________________________________ 
                                                         (If more, attach list) 

9. Paid-in Capital:    $ ________________________________
(“Paid-in Capital” replaces the terms Stated Capital & Paid-in Surplus and is equal to the total of these accounts.)

10. (a) Give an estimate of the total value of all the property* of the
        corporation for the following year:                                     $ ________________________________________
(b)     Give an estimate of the total value of all the property* of the
        corporation for the following year that will be located in Illinois:    $ ________________________________________
(c)     State the estimated total business of the corporation to be
        transacted by it everywhere for the following year:                     $ ________________________________________
(d)     State the estimated annual business of the corporation to be
        transacted by it at or from places of business in the State of
        Illinois:                                                               $ ________________________________________

11. Interrogatories: (Important - this section must be completed.)
(a)     Is the corporation transacting business in this state at this time?
(b)     If the answer to item 11(a) is yes, state the exact date on which it commenced to transact business in Illinois:

12. This application is accompanied by a certified copy of the articles of incorporation, as amended, duly authenticated, within the last
ninety (90) days, by the proper officer of the state or country wherein the corporation is incorporated.

13. The undersigned corporation has caused this application 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)
*       PROPERTY as used in this application shall apply to all property of the corporation, real, personal, tangible, intangible, or
        mixed without qualifications.

Note 1 — Payment in connection with this application must be in the form of a certified check, cashier’s check, Illinois attorney 
or CPA’s check or money order made payable to the “Secretary of State.” The minimum fee due upon qualification is $150. Any 
additional fees will be billed and must be paid before this application can be filed. 
• Please see filing periods set forth below regarding the franchise tax exemption amount for each year. (Tax amount minus
  exemption amount. If a negative number, no franchise tax due.)

Franchise Tax Liability Exemption Amounts 

        FILING PERIOD EXEMPTION AMOUNT 
        After 1/1/21     Exemption $1,000.00 

•       The minimum total due (franchise tax + filing fee) is $150.