Application For Reinstatement Domestic/foreign Corporations ...
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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
Jesse White, Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, 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. March 2007 - 10M - C 219.12
NOTES
1. All fees in 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 for-
eign corporation is no longer available at the time of reinstatement, Forms NFP 113.40 and NFP 104.15 must accom-
pany 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.
Printed by authority of the State of Illinois. March 2007 - 10M - C 219.12
