Report Following Merger or Consolidation (Illinois)
This form reports shares following a merger or consolidation of business in Illinois. The form provided here is simply a sample of what the actual Form BCA-14.35 looks like
Form BCA-14.35
Jesse White
Secretary of State
Department of Business Services
Springfield, IL 62756
Telephone (217) 785-2237
https://www.sos.state.il.us
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File # ________________________________
Date ________________________________
License Fee $________________________________
Franchise Tax $________________________________
Filing Fee $5.00
Penalty $________________________________
Interest $________________________________
Approved: ________________________________
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REPORT FOLLOWING MERGER OR CONSOLIDATION
1. CORPORATE NAME: _________________________________
2. STATE OR COUNTRY OF INCORPORATION: _________________________________
3. Issued shares of each corporation party to the merger prior to the merger:
Corporation _________________________________
Class _________________________________
Series _________________________________
Par Value _________________________________
Number of Shares _________________________________
Corporation _________________________________
Class _________________________________
Series _________________________________
Par Value _________________________________
Number of Shares _________________________________
Corporation _________________________________
Class _________________________________
Series _________________________________
Par Value _________________________________
Number of Shares _________________________________
4. Paid-in Capital of each corporation party to the merger prior to the merger:
Corporation _________________________________
Paid-in Capital $_________________________________
Corporation _________________________________
Paid-in Capital $_________________________________
Corporation _________________________________
Paid-in Capital $_________________________________
5. Description of the merger: (Include effective date and a brief explanation of the conversion as stated in the plan of merger.)
_________________________________
_________________________________
6. Issued shares after merger:
Class _________________________________
Series _________________________________
Par Value _________________________________
Number of Shares _________________________________
Class _________________________________
Series _________________________________
Par Value _________________________________
Number of Shares _________________________________
7. Paid-in Capital of the surviving or new corporation: $_________________________________
("Paid-in Capital" replaces the terms Stated Capital & Paid-in Surplus and is equal to the total of these accounts.)
ITEM 8 MUST BE SIGNED
8. 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)