Reset
FORM     NFP 113.15       (rev. Dec. 2003)
APPLICATION FOR 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
217-782-1834
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 Secretary of State.

___________________________________ File #______________________________    Filing Fee: $50                    Approved: ___________
    ———— Submit in duplicate ———— Type or Print clearly in black ink ———— Do not write above this line ———— 
1. a. Corporate Name:  _____________________________________________________________________________

   b. 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. Date of Incorporation: __________________________________________________________________________
   c. Period of Duration:_____________________________________________________________________________
3. a. Address of Principal Office, wherever located: _______________________________________________________
     ____________________________________________________________________________________________
   b. Address of Principal Office in Illinois: ______________________________________________________________
         ____________________________________________________________________________________________
4. Name and Address of Registered Agent and Registered Office in Illinois:

    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

5. States and Countries in which Corporation is admitted or qualified to conduct affairs: __________________________

6. Names and respective addresses of Corporation’s officers and directors:
                                                     Street Address              City                                      State       ZIP

President
Secretary
Director
Director
Director
                         If there are additional officers or more than three directors, please attach list.

                                     Printed by authority of the State of Illinois. January 2015 - 1 - C 160.15

7. Purpose(s) for which the Corporation is organized and proposes to pursue in the conduct of affairs in this State:
                                 For more space, attach additional sheets of this size.

8. This application must be accompanied by an originally certified copy of the Articles of Incorporation and any amend-
ments or mergers, duly authenticated within the last 90 days by the proper officer of the state or country wherein the
corporation is incorporated.

9. 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)

A Corporation that is to function as a club, as defined in Section 1-3.24 of the Liquor Control Act of 1934, must insert in its
purpose clause a statement that  it will comply with the State and local laws and ordinances relating to alcoholic
liquors.