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FORM   BCA 1.15       (rev. Dec. 2003) 
STATEMENT OF     CORRECTION
Business Corporation Act
Secretary of State
Department   of Business Services
501 S. Second   St., Rm. 350 
Springfield, IL 62756
217-785-2237
www.ilsos.gov
Remit payment in the form of a 
check   or money order payable 
to Secretary of State.                 File #________________________

Franchise Tax $________________ Penalty/Interest $________________   Filing Fee: $50 Total $_____________  Approved: ______
    ———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ———— 

1. Corporate Name: ________________________________________________________________________________

2. State or Country of Incorporation: ___________________________________________________________________

3. Title of Document to be corrected:___________________________________________________________________

4. Date Erroneous Document was filed by Secretary of State: _______________________________________________

5. Inaccuracy, error or defect:
   (Briefly identify the error and explain how it occurred. Use reverse side or attach additional sheets of this size if neces-
   sary.)

6. Corrected portion(s) of the document in correct form:
   (Use reverse side or attach additional sheets of this size if necessary.)

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 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)

                                  Printed by authority of the State of Illinois. January 2015 - 1 - C 199.12






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