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FORM NFP 113.40 (rev. Jan. 2022) 
APPLICATION FOR AMENDED 
AUTHORITY TO CONDUCT AFFAIRS 
IN ILLINOIS (Foreign Corporations) 
General Not For Profit Corporation Act 
 
Secretary of State 
Department of Business Services 
501 S. Second St., Rm. 350 
Springfield, IL  62756 
217-782-6961 
ilsos.gov 
 
Remit payment in the form of a  
check or money order payable  
to Secretary of State. 
      
____________________________________ File #_____________________________    Filing Fee: $25     Approved: ___________ 
 
  ———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ————  
 
1. Corporate Name: ________________________________________________________________________________ 
 
  If a Change of Name is being reported, the new corporate name: __________________________________________ 
 
  Assumed Corporate Name (Complete only if the new corporate name is not available in this state.): 

  ______________________________________________________________________________________________ 
  By electing this assumed name, the Corporation hereby agrees NOT to use its corporate name in the transaction of 
  business in Illinois. Form NFP 104.15 is attached. 

2. a. State or country of incorporation: __________________________________________________________________ 

  b. If changed, period of duration: ____________________________________________________________________ 

3. If changed, purpose(s) for which it is organized and proposes to pursue in the conduct of affairs in this state. 
                       For more space, use reverse side or attach additional sheets of this size. 
                                                              
4. This application is accompanied by a copy of the Articles of Amendment to the Articles of Incorporation, if any, as evi-
  dence of any change of name, duration or purpose reported herein, such copy being duly authenticated by the proper 
  officer of the state or country wherein the corporation is incorporated, which certification is not more than 90 days old. 
  The filing fee for the certified copy of the Articles of Amendment is $25 unless the amendment acts as a restatement of 
  Articles of Incorporation, in which case the filing fee is $100. In the event the statutory change was effected in a merger, 
  a certified copy of the merger is required, plus applicable fee. The fees outlined in this paragraph are in addition to the 
  $25 filing fee set forth. 

5. 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 Officerʼs Signature 

               ______________________________________ 
                       Name and Title (type or print) 
                                Printed by authority of the State of Illinois. January 2022 — 1 — C 218.10