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FORM NFP 112.45/113.60(rev. Dec. 2003)
APPLICATION FOR REINSTATEMENT
DOMESTIC/FOREIGN CORPORATIONS
General Not For Profit Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
S pringfield, IL 62756
217-782-5797
217-785-5782
www.cyberdriveillinois.com
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 Secretary
of State. DO NOT SEND CASH.

____________________________________ File #_____________________________    Filing Fee: $25              Approved: ___________
———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ———— 

1. a.Corporate Name as of date of issuance of Certificate of Dissolution or Revocation:
____________________________________________________________________________________________
b.Corporate Name if changed (See Note 2 on back.):       _________________________________________________
c.If a foreign corporation having authority to conduct affairs under an assumed corporate name restriction, the
Assumed Corporate Name (See Note 3 on back.):
____________________________________________________________________________________________
2. State of Incorporation:____________________________________________________________________________
3. Date Certificate of Dissolution or Revocation was issued:________________________________________________
4.  Name and Address of Registered Agent and Illinois Registered Office upon reinstatement:

Registered Agent:_______________________________________________________________________________
                           First Name                       Middle Name                                  Last Name

Registered Office:_______________________________________________________________________________
                               Number                       Street              Suite # (P.O. Box alone is unacceptable)

Registered Office_______________________________________________________________________________
                               City                         ZIP Code                                     County

NOTE: completion of Article 4 does not constitute a registered agent or office change. (See Note 4 on back.)
5. This application is accompanied by all delinquent reports together with the filing fees and penalties required. (See Note
1 on back.)

6. 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

     ______________________________________
                      Name and Title (type or print)

                               Printed by authority of the State of Illinois. January 2015 - 1 - C 219.13

                                           NOTES

1. All feesin connection with the reinstatement must be in the form of a certified check, cashier’s check, Illinois attor-
   ney’s or CPA’s check or money order payable to Secretary of State. This method of payment includes all filing fees
   and penalties.

2. If the corporation has changed its name subsequent to the date of dissolution or revocation, Form NFP 113.40 must
   be filed for foreign corporations, along with a certified copy of the Articles of Amendment, as duly authenticated by the
   proper governmental authority from its State of incorporation giving evidence to the name change; Form NFP 110.30
   must be filed for domestic corporations.

3. This item must be completed if either the true name of a foreign corporation was not available at the time of qualifica-
   tion or the foreign corporation’s true name is now not available at the time of reinstatement. If the true name of the
   foreign corporation is no longer available at the time of reinstatement, Forms NFP 113.40 and NFP 104.15 must
   accompany the other documents pertaining to the reinstatement. If the renewal date for the assumed name is prior to
   the date of signing in Item 6, an assumed name renewal statement must accompany the reinstatement application.

4. If either or both the registered agent or the registered office of the corporation has changed since the time of dissolu-
   tion or revocation, the corporation shall properly report such a change on Form NFP 105.10/105.20.