Statement Of Cancellation Of Non-Reissuable Shares (Illinois)
This form is a statement of cancellation of non-reissuable shares of stock in Illinois. The form provided here is simply a sample of what the actual Form BCA-9.05 looks like.
File # ________________________________
Form BCA-9.05
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
Remit payment in check or money order, payable to "Secretary of State."
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SUBMIT IN DUPLICATE
This space for use by Secretary of State
Date ________________________________
Filing Fee $5.00
Approved: ________________________________
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STATEMENT OF CANCELLATION
of
NON-REISSUABLE SHARES
1. CORPORATE NAME: __________________________
2. The corporation has acquired and cancelled its own shares, and the articles of incorporation prohibit the re-issuance of such shares.
3. Number of shares cancelled and redemption or purchase price:
Class __________________________
Series __________________________
Par Value __________________________
Number of Shares Cancelled __________________________
Redemption or Purchase Price __________________________
Date of Cancellation __________________________
4. Number of authorized shares:
BEFORE CANCELLATION
Class __________________________
Series __________________________
Par __________________________
Number __________________________
AFTER CANCELLATION
Class __________________________
Series __________________________
Par __________________________
Number __________________________
5. Number of issued shares:
BEFORE CANCELLATION
Class __________________________
Series __________________________
Par __________________________
Number __________________________
AFTER CANCELLATION
Class __________________________
Series __________________________
Par __________________________
Number __________________________
6. Paid-in capital (Before Cancellation): $__________________________
6. Paid-in capital (After Cancellation): $__________________________
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. (All signatures must be in BLACK INK.)
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:
This form is applicable only where the articles of incorporation provide that shares redeemed or purchased shall be cancelled and shall not be re-issued. Upon such redemption and cancellation of shares, the paid-in capital of the corporation is deemed to be reduced by that part of the paid-in capital which was represented by the shares so cancelled. The filing of this statement operates as an amendment to the articles of incorporation and reduces the number of shares of the class so redeemed which the corporation is authorized to issue by the number of shares so redeemed and canceled.