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FORM NFP-105.25        (rev. Dec. 2014) 
AFFIDAVIT OF COMPLIANCE FOR 
SERVICE ON SECRETARY OF STATE
Under the General Not For Profit Corporation Act
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL  62756
217-782-6961
www.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 (5) 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          d. ❏  The corporation’s authority to transact business in Illinois has been withdrawn/revoked (circle one) on 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 2015 — 1 — C 221.5

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

              is most likely to result in actual                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        INSTRUCTIONS