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Application To Adopt, Change Or Cancel, An Assumed Corporate Name (Illinois)

This form is to adopt, change, or cancel an assumed company, corporation, etc. name in Illinois. The form provided here is simply a sample of what the actual Form BCA-4.15/4.20 looks like.

Form BCA-4.15/4.20

Jesse White
Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 785-2237
(217) 785-6033
https://www.sos.state.il.us

APPLICATION TO ADOPT, CHANGE OR CANCEL, AN ASSUMED CORPORATE NAME

Remit payment in check or money order, payable to "Secretary of State."

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File # ________________________________

SUBMIT IN DUPLICATE

This space for use by Secretary of State

Date ________________________________

Filing Fee $_______________________________

Approved: ________________________________


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1. CORPORATE NAME: ________________________________

2. State or Country of Incorporation: ________________________________

3. Date incorporated (if an Illinois corporation) or date authorized to transact business in Illinois (if a foreign corporation):

_____________________________ (Month & Day), _________ (Year).

(Complete No. 4 and No. 5 if adopting or changing an assumed corporate name.)

4. The corporation intends to adopt and to transact business under the assumed corporate name of:

________________________________

5. The right to use the assumed corporate name shall be effective from the date this application is filed by the Secretary of State

until _____________________ (Month & Day), ________ (Year), the first day of the corporation's anniversary month in the next year which is evenly divisible by five.

(Complete No. 6 if changing or cancelling an assumed corporate name.)

6. The corporation intends to cease transacting business under the assumed corporate name of:

________________________________

7. The undersigned corporation has caused this statement to be signed by its duly authorized officers, each of whom affirms, under penalties of perjury, that the facts stated herein are true.

Dated ________________________ (Month & Day), __________ (Year)

________________________________ (Exact Name of Corporation)

attested by ___________________________________ (Signature of Secretary or Assistant Secretary)

________________________________ (Type or Print Name and Title)

by ________________________________ (Signature of President or Vice President)

________________________________ (Type or Print Name and Title)

NOTE: The filing fee to adopt an assumed corporate name is $20 plus $2.50 for each month or part thereof between the date of filing this application and the date upon which the corporation may renew its use.

The fee for canceling an assumed corporate name is $5.00.

The fee to change an assumed name is $25.

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