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Statement Of Election To Establish An Extended Filing Month (Illinois)

This form is to extend the filing month in Illinois. The form provided here is simply a sample of what the actual Form BCA-14.01 looks like.

Form BCA-14.01

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

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

-------------------------------

File # ________________________________

SUBMIT IN DUPLICATE

This space for use by Secretary of State

Date ________________________________

Filing Fee $25.00

Approved: ________________________________


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STATEMENT OF ELECTION TO ESTABLISH AN EXTENDED FILING MONTH


1. CORPORATE NAME: ______________________________

2. State or Country of Incorporation: ______________________________

3. Date Incorporated/Qualified: ______________________________

4. Date of fiscal year end immediately preceding this election: ______________________________

5. Extended filing month (See Note 2.): ______________________________

6. This Statement of Election is accompanied by an Interim Annual Report, which shall set forth, as of the date of filing of the statement, all of the information required pursuant to Section 14.05 of the Business Corporation Act to be included in the annual report, except that the information required by subparagraph (h) of Section 14.05 shall be the amounts represented in this state as disclosed by the preceding annual report, or, if no annual report is on file, from information contained in the articles of incorporation of a domestic corporation or the application for certificate of authority in the case of a foreign corporation.

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)


IMPORTANT!

FOR A CORPORATION SEEKING TO ESTABLISH AN EXTENDED FILING MONTH, SECTION 14.01 OF THE BUSINESS CORPORATION ACT REQUIRES THIS DOCUMENT BE FILED PRIOR TO THE FIRST DAY OF THE CORPORATION'S ANNIVERSARY MONTH.

NOTES

Note 1:

Each domestic corporation and each foreign corporation authorized to transact business in this state, having reported on its last annual report or if no annual report is on file, on the articles of incorporation of a domestic corporation or on the application for certificate of authority of a foreign corporation, an amount less than 100 percent of its paid-in capital represented in Illinois, may make an irrevocable, one time election to establish an extended filing month for the purpose of filing annual reports for all subsequent taxable years.

Note 2:

The extended filing month may be any month in that is one of the nine months consecutively following the end of the corporation's fiscal year, except that the extended filing month may not be one of the two months immediately preceding the corporation's anniversary month. Notwithstanding the foregoing, a corporation whose fiscal year ends within the two months immediately preceding its anniversary month may not elect an extended filing month.

Note 3:

When filing an Interim Annual Report DO NOT complete items 9 or 10. In calculating the interim annual franchise tax, the corporation must use the factor established from its last annual report or, if no annual report is on file, on the articles of incorporation of a domestic corporation or on the application for certificate of authority of a corporation. This factor appears in item 7x of the preprinted annual report recently mailed to the corporation.


DOMESTIC/FOREIGN CORPORATION INTERIM ANNUAL REPORT

Please Type or Print Clearly in Black Ink

1. CORPORATE NAME ____________________________________

REGISTERED AGENT ____________________________________

REGISTERED OFFICE ____________________________________

CITY ____________________________________, IL

ZIP CODE ____________________________________

2. (a) Date of Incorporated/Qualified: _____________________________

(b) State or Country of Incorporation: _____________________________

3. (a) Give complete address of principal office, if other than above.

____________________________________

____________________________________

3. (b) FEIN No.: ____________________________________

4. Names and residential addresses of the officers and directors (If officers are directors, so state.):

President Name ____________________________________

Number & Street ____________________________________

City ____________________________________

State ____________________________________

ZIP ____________________________________

Secretary Name ____________________________________

Number & Street ____________________________________

City ____________________________________

State ____________________________________

ZIP ____________________________________

Treasurer Name ____________________________________

Number & Street ____________________________________

City ____________________________________

State ____________________________________

ZIP ____________________________________

Director Name ____________________________________

Number & Street ____________________________________

City ____________________________________

State ____________________________________

ZIP ____________________________________

Director Name ____________________________________

Number & Street ____________________________________

City ____________________________________

State ____________________________________

ZIP ____________________________________

5. Type of business actually conducted in Illinois: ____________________________________

6. Authorized and issued shares as of ____________________ (Date):

Class ____________________________________

Series ____________________________________

Par Value ____________________________________

Number Authorized ____________________________________

Number issued ____________________________________

Class ____________________________________

Series ____________________________________

Par Value ____________________________________

Number Authorized ____________________________________

Number issued ____________________________________

Class ____________________________________

Series ____________________________________

Par Value ____________________________________

Number Authorized ____________________________________

Number issued ____________________________________

7. (a) Paid-in capital as of ____________________________________ (Date):

(b) Paid-in Capital as of ____________________________________ (Date),

PAID-IN CAPITAL $__________________ on record with the Secretary of State:

("Paid-in Capital" replaces the terms "Stated Capital" and "Paid-in Surplus." It does not include Retained Earnings.)

TOTAL $ _____________________________

(x) Previous Allocation Factor: ____________________________________

ITEM 8 MUST BE SIGNED

8. By ____________________________________ (Authorized Officer's Signature)

____________________________________ (Title)

____________________________________ (Date)

Under penalty of perjury and as an authorized officer, I declare that this annual report and, if applicable, the statement of change of registered agent and/or office, pursuant to provisions of the Business Corporation Act, has been examined by me and is, to the best of my knowledge and belief, true, correct, and complete.

9. Omitted

10. Omitted

11. INTERIM ANNUAL FRANCHISE TAX AND FEES

(a.) Total Paid-in Capital (Enter the GREATER of item 7a or item 7b from other side of this annual report form).................................... a _________________________

(b.) ALLOCATION FACTOR (Enter from item 7x from other side of this annual report) ...................... b _________________________

(c.) ILLINOIS CAPITAL (Multiply line (a) by line (b).).......................... c _________________________

(d1.) Illinois Capital (Enter from line (c).).............. d1 _________________

(d2.) Multiply line (d1) by .001 (Round to nearest cent.) ....................... d2 _________________________

(d3.) ANNUAL FRANCHISE TAX (Enter amount from line (d2), but not less than $25.) ........... d3 _________________________

(e.) If Interim Annual Report is late, multiply line (d3) by .10 (Penalty) ..................................... e _________________________

(f.) If Interim Annual Franchise Tax is late, multiply line (e3) by .01 for each month or part thereof late (minimum $1.00) (Interest) .............................................. f _________________________

(g.) ANNUAL REPORT FILING FEE ($25) ......................... g +25.00

(h.) TOTAL ANNUAL FRANCHISE TAX, FEES & PENALTIES DUE
(Add line d3 + line e + line f + line g.) ...................................................... h _________________________

12. Section 14.01 of the Business Corporation Act requires that this document must be submitted with the Statement of Election to Establish an Extended Filing Month and the required $25 filling fee.

ITEM 8 MUST BE SIGNED

REMIT CHECK OR MONEY ORDER, PAYABLE TO "SECRETARY OF STATE," IN THE TOTAL AMOUNT DUE LISTED ON LINE 11h. THIS FEE MUST BE SUBMITTED WITH THIS ANNUAL REPORT FORM! IF THE PROPER REMITTANCE IS NOT ENCLOSED, THIS REPORT WILL NOT BE ACCEPTED FOR FILING, AND A LATE PENALTY MAY BE ASSESSED.

Your canceled check is your receipt.

IMPORTANT!

THIS FORM MAY ONLY BE USED IN CONNECTION WITH FORM BCA-14.01 AND MAY NOT BE SUBMITTED INDEPENDENTLY.

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