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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.cyberdriveillinois.com
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