FORM NFP-105.25 (rev. Dec. 2014) 
AFFIDAVIT OF COMPLIANCE FOR  
SERVICE ON SECRETARY OF STATE 
Under the 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 
 
Payment must be made by check or money  
order payable to Secretary of State.  
 
                 Filing Fee: $10           File #: ___________________________     Approved: ______________________ 
 
 ________ Submit in duplicate ________ Type or Print clearly in black ink ________ Do not write above this line ________  
 
1.       Title and Number of Case: 
           
           ________________________________             first named plaintiff 
                                V.                                                                                       Number: _______________
           ________________________________             first named defendant 
 
2.       Name of corporation being served: ____________________________________________________________ 
 
3.       Title of court in which an action, suit or proceeding has been commenced: _____________________________ 
 
4.       Title of instrument being served: ______________________________________________________________ 
 
5.       Basis for service on the Secretary of State: (check and complete appropriate box) 
 
            a.  ❏     The corporation’s registered agent cannot with reasonable diligence be found at the registered office of 
                          record in Illinois. 
 
            b.  ❏     The corporation has failed to appoint and maintain a registered agent in Illinois. 
 
            c.   ❏     The corporation was dissolved on ___________________________ ,  _________ ; the conditions 
                                                                                  Month, Day                                         Year
                          of paragraphs (a) or (b) above exist; and the action, suit or proceeding has been instituted against or 
                          has affected the corporation within five years thereafter. 
 
            d.  ❏     The corporation’s authority to transact business in Illinois has been withdrawn/revoked (circle one) on 
                           
                          ________________________ ,  ___________ . 
                           Month, Day                                         Year
            e.  ❏     The corporation is a foreign corporation that has conducted affair in Illinois without procuring authority,  
                          contrary to the provisions of the Business Corporation Act of 1983. 
 
6.       Address to which the undersigned will cause a copy of the attached process, notice or demand to be sent by certified  
         or registered mail:__________________________________________________________________________ 
 
7.       The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete. 
 
         _________________________________________    _____________________________    ___________ 
                           Signature of Affiant                                                Month, Day                                                Year
                                                   __________________________________________ (                         )
                                                                               Telephone Number
Return to (please type or print clearly): 
 
         ____________________________________ 
                           Name
         ____________________________________ 
                           Street
         ____________________________________ 
                 City/Town                                       State      Zip
                                   Printed by authority of the State of Illinois. January 2023 — 1 — C 221.6

              INSTRUCTIONS 
 
Deliver to the Secretary of State: 
 
1.   Copy of process, notice or demand; 
2.   Copy of any papers to be served  
      therewith; 
3.   Affidavit of Compliance for Service on  
      Secretary of State; and 
4.   $10 fee. 
 
This affidavit will be stamped with the date 
of filing and returned to the affiant as the 
only proof of filing. 
 
After proof of filing has been received, 
transmit to the corporation being served 
by CERTIFIED or REGISTERED mail: 
 
1.   Copy of process, notice or demand; 
2.   Copy of any papers to be served  
      therewith; 
3.   Copy of filed Affidavit of Compliance  
      for Service on Secretary of State. 
 
Transmittal to the corporation being 
served shall be: 
 
1.   At the last registered office of the   
      corporation as shown on the records 
      of the Secretary of State; 
 
AND 
 
2.   At such address the use of which the  
      person instituting the action, suit or  
      proceeding knows, or on the basis of  
      reasonable inquiry has reason to  
      believe, is most likely to result in actual  
      notice.