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Application for Reservation of Name (Illinois)

This form is to a reserve a company, corporation, etc. name in Illinois. The form provided here is simply a sample of what the actual Form BCA-4.10 looks like.

Form BCA-4.10

Jesse White
Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 785-2237
(217) 785-6033

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

Filing fee is $25 for each name reserved.


File # ________________________________


This space for use by Secretary of State

Date ________________________________

Filing Fee $_______________________________

Approved: ________________________________



1. Name or names to be reserved (for a period of 90 days each):

________________________________ (Shall contain the word "corporation," "company," "incorporated" or limited," or shall contain an abbreviation of one such words)

2. Proposed corporate purpose: ________________________________

3. Name of applicant ________________________________

4. Address of applicant ________________________________

5. Dated _________________________ (Month & Day), ________ (Year)


________________________________ (Signature of Applicant)


NOTE: If applicant is an individual, this application is to be signed by the applicant.

If the applicant is a corporation, this application is to be signed by the corporation's President or Vice President and verified by him and attested to by the Secretary or an Assistant Secretary.

Upon filing of this document, the name(s) will be reserved for a period of 90 days.



Date ________________________________

Filing Fee $25.00

Approved: ________________________________


The undersigned _____________________________ (Name of Original Applicant) hereby transfers

to _____________________________ (Name of Transferee)

the right to use the name _____________________________ for corporate purposes in Illinois.

This name was reserved on __________________ (Month & Day), ________ (Year).

The undersigned affirms, under penalties of perjury, that the facts stated herein are true.

Dated __________________________________ (Month & Day), ________ (Year)

by ____________________________ (Signature of Original Applicant)

attested by ______________________________________

_____________________________ (Type or Print Name) If a corporation, by its President or Vice President*

* As the original applicant, I declare that this document has been examined by me and is, to the best of my knowledge and belief, true, correct and complete.

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