Illinois Corporation Annual Report Form

Illinois Corporation Annual Report.pdf This form must be filed every year to renew a domestic corporation in Illinois. The fee is the franchise tax calculation plus $75. Send fee and completed form to

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YEAR OF: STATE OF ILLINOIS CORPORATION
File Prior to: DOMESTIC CORPORATION ANNUAL REPORT File #: ________________
Note: A change in the Registered Agent and/or Registered Office may only be effected by filing Form BCA-5.10/5.20. If there have
been any changes in items 6 or 7a, Form BCA-14.30 must be completed and submitted in the same envelope.
1. Corporate Name:
Registered Agent:
Registered Office:
City, IL, ZIP Code: County:
2. Principal Address of Corporation: ____________________________________________________________________________
Street City State ZIP Code
3. Date Incorporated:__________________________________
Month Day Year
4. Names and Addresses of Officers and Directors:
NOTE: The names and addresses of ALL officers and directors must be entered in this item.
OFFICE NAME NUMBER & STREET CITY STATE ZIP
President
Secretary
Treasurer
Director
Director
Director
5. If 51% or more of stock is owned by a minority or female, please check appropriate box: ■ Minority Owned ■ Female Owned
6. Number of shares authorized and issued (as of ________________________):
CLASS SERIES PAR VALUE NUMBER AUTHORIZED NUMBER ISSUED
President
Secretary
Treasurer
Director
Director
Director
IMPORTANT: If the amount in item 6 or 7a differs from the Secretary of Stateʼs records, form BCA 14.30 must be completed.
7a. Amount of Paid-in Capital (as of ___________________ ): $ _________________
7b. Paid-in Capital on record with Secretary of State: $ _________________________
8. By: _______________________________________________________________
Any Authorized Officerʼs Signature Title Date
Item 8 Must Be Signed.
RETURN TO:
Jesse White, Secretary of State
Department of Business Services • 501 S.Second St. • Springfield, IL 62756
217-782-7808 • www.cyberdriveillinois.com
Please Complete Reverse Side of This Report
PRESIDENT
SECRETARY
IF THE ABOVE OFFICER’S NAMES AND ADDRESSES ARE MISSING OR HAVE _______________
CHANGED, ENTER ONLY THE ADDITION OR CORRECTIONS BELOW. File #
PRESIDENT _________________________________________________________________________________________________
Name Street Address City State ZIP Code
SECRETARY_________________________________________________________________________________________________
Name Street Address City State ZIP Code
(Paid-in Capital reflects the sum of the Stated
Capital and Paid-in surplus accounts.)
Under the penalty of perjury and as an authorized
officer, I declare that this annual report, 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.
Printed by authority of the State of Illinois. July 2011 — 5M — C 289.9(Item 9 OR 10a OR 10b, whichever is applicable, MUST be completed.)
9. Amounts stated in parts (a) through (d) below are given for the 12-month period
ending ________________________________________ , ________________.
Day Month Year
Value of property (gross assets):
(a) owned by the corporation, wherever located:……………………………………………………. (a) $ ______________________
(b) of the corporation located within the State of Illinois:………………………………………….. (b) $ ______________________
Gross amount of business transacted by the corporation:
(c) everywhere for the above period: ……………………………………………………………………. (c) $ ______________________
(d) at or from places of business in Illinois for the above period:………………………………. (d) $ ______________________
ALLOCATION FACTOR = b + d = ____________________ Enter this figure on line 11b below.
a + c = 6 decimal places
10a. ■ ALL property of the Corporation is located in Illinois and ALL business of the Corporation is transacted at or from places of business in Illinois.
10b. ■ The Corporation elects to pay franchise tax on the basis of 100% of its total Paid-in Capital.
ALLOCATION FACTOR = 1.00000 (Enter this figure on line 11b below.)
STOP: Item 9 or 10 must be completed before continuing to Item 11.
11. ANNUAL FRANCHISE TAX AND FEES
11a. TOTAL PAID-IN CAPITAL (Enter amount from Item 7a;
if late, enter the greater of 7a or 7b.) ……………………………………………………………_________________________
11b. ALLOCATION FACTOR (Enter from Item 9 or Item 10.)…………………………………._________________________
11c. ILLINOIS CAPITAL (Multiply line 11a by line 11b.)………………………………………….________________________
11d1. Multiply line 11c by .001 (Round to nearest cent.) ………………………………………….
11d2. ANNUAL FRANCHISE TAX (Enter amount from line d1, but not less than $25)…………………………………………… d2.
11e1. If Annual Report is late, multiply line d2 by .10 ………………………………………………________________________
11e2. If Annual Franchise Tax is late, multiply line d2 by .02 for each month
late or part thereof (minimum $1)…………………………………………………………………________________________
11e3. INTEREST & PENALTIES (Add lines e1 and e2.)…………………………………………………………………………………….
e3.
11f. ANNUAL REPORT FILING FEE ($75) ……………………………………………………………………………………………………
11f.
11g. TOTAL ANNUAL FRANCHISE TAX, FEES, INTEREST, PENALTIES DUE
(Add line d2 + line e3 + line f.)……………………………………………………………………………………………………………….
11g.
MAKE CHECKS PAYABLE TO ILLINOIS SECRETARY OF STATE.
(Place corporate file number on check.)
IMPORTANT:
If there have been changes in Items 6 or 7, Form BCA 14.30 must be executed
and submitted with this Annual Report in the same envelope.
.
Printed by authority of the State of Illinois. July 2011 — 5M — C 289.9
a.
b.
c.
d1
e1.
e2.
$75.00