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FORM NFP 101.15 (rev. Dec. 2003) STATEMENT OF CORRECTION General Not For Profit Corporation Act Jesse White, 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.
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____________________________________ File #______________________________
Filing Fee: $25
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 the Secretary of State: ____________________________________________ 5. Briefly identify the inaccuracy, error or defect to be corrected:
6. Corrected portion(s) of the document in like format: For more space, attach additional sheets of this size.
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 Any Authorized Officer's Signature Year
________________________________________________
Exact Name of Corporation
______________________________________ ______________________________________
Name and Title (type or print)
Printed by authority of the State of Illinois. May 2007 - 1M - C 224.9