FORM BCA 1.15 (rev. Dec. 2003) STATEMENT OF CORRECTION Business Corporation Act Secretary of State Department of Business Services 501 S. Second St., Rm. 350 Springfield, IL 62756 217-785-2237 www.cyberdriveillinois.com Remit payment in the form of a check or money order payable to Secretary of State. Print Reset Save File #________________________ Franchise Tax $________________ Penalty/Interest $________________ Filing Fee: $50 Total $_____________ Approved: ______ -------- Submit in duplicate -------- Type or Print clearly in black ink -------- Do not write above this line -------- 1. Corporate Name: ________________________________________________________________________________ 2. State or Country of Incorporation: ___________________________________________________________________ 3. Title of Document to be corrected:___________________________________________________________________ 4. Date Erroneous Document was filed by Secretary of State: _______________________________________________ 5. Inaccuracy, error or defect: (Briefly identify the error and explain how it occurred. Use reverse side or attach additional sheets of this size if necessary.) 6. Corrected portion(s) of the document in correct form: (Use reverse side or attach additional sheets of this size if necessary.) 7. The undersigned Corporation has caused this statement to be signed by a duly authorized officer who affirms, under penalties of perjury, that the facts stated herein are true and correct. All signatures must be in BLACK INK. Dated _______________________________ , _____ Month & Day Year Any Authorized Officer's Signature Name and Title (type or print) ______________________________________ ______________________________________ ________________________________________________ Exact Name of Corporation Printed by authority of the State of Illinois. January 2015 - 1 - C 199.12 American LegalNet, Inc. www.FormsWorkFlow.com