FORM BCA-5.25 (rev. Dec. 2014) AFFIDAVIT OF COMPLIANCE FOR SERVICE ON SECRETARY OF STATE Business Corporation Act Department of Business Services 501 S. Second St., Rm. 350 Springfield, IL 62756 217-782-6961 www.cyberdriveillinois.com Payment must be made by check or money order payable to Secretary of State. Filing Fee: $10 1. ________ Submit in duplicate ________ Type or Print clearly in black ink ________ Do not write above this line ________ File #: ___________________________ Approved: ______________________ Title and Number of Case: V. ________________________________ 2. 3. Name of corporation being served: ____________________________________________________________ ________________________________ first named plaintiff first named defendant Number: _______________ 4. Title of court in which an action, suit or proceeding has been commenced: _____________________________ Basis for service on the Secretary of State: (check and complete appropriate box) a. b. 5. Title of instrument being served: ______________________________________________________________ The corporation's registered agent cannot with reasonable diligence be found at the registered office of record in Illinois. The corporation has failed to appoint and maintain a registered agent in Illinois. Month Day Year c. d. e. The corporation was dissolved on ___________________________ , _________ ; the conditions of paragraphs (a) or (b) above exist; and the action, suit or proceeding has been instituted against or has affected the corporation within five (5) years thereafter. ________________________ , ___________ . Month Day Year The corporation's authority to transact business in Illinois has been withdrawn/revoked (circle one) on The corporation is a foreign corporation that has transacted business in Illinois without procuring authority, contrary to the provisions of the Business Corporation Act of 1983. 6. 7. Address to which the undersigned will cause a copy of the attached process, notice or demand to be sent by certified or registered mail:__________________________________________________________________________ _________________________________________ The undersigned affirms, under penalties of perjury, that the facts stated herein are true, correct and complete. Month Day Signature of Affiant () __________________________________________ Telephone Number _____________________________ ___________ Year Return to (please type or print clearly): Name ____________________________________ City/Town State Zip ____________________________________ Street ____________________________________ Printed by authority of the State of Illinois. January 2015 -- 1 -- C 213.11 American LegalNet, Inc. www.FormsWorkFlow.com 2. At such address the use of which the person instituting the action, suit or proceeding knows, or on the basis of reasonable inquiry has reason to believe, is most likely to result in actual notice. AND 1. At the last registered office of the corporation as shown on the records of the Secretary of State; Transmittal to the corporation being served shall be: 1. Copy of process, notice or demand; 2. Copy of any papers to be served therewith; 3. Copy of filed Affidavit of Compliance for Service on Secretary of State. After proof of filing has been received, transmit to the corporation being served by CERTIFIED or REGISTERED mail: This affidavit will be stamped with the date of filing and returned to the affiant as the only proof of filing. 1. Copy of process, notice or demand; 2. Copy of any papers to be served therewith; 3. Affidavit of Compliance for Service on Secretary of State; and 4. $10 fee. Deliver to the Secretary of State: American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS