Reset
FORM NFP 101.15       (rev. Dec. 2003)
STATEMENT OF CORRECTION
General Not For Profit Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350 
Springfield, IL  62756
217-785-2237
www.ilsos.gov

Remit payment in the form of a 
check or money order payable 
to Secretary of State.

____________________________________ 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                       Year                   Exact Name of Corporation

          ______________________________________
                      Any Authorized Officer’s Signature

          ______________________________________
                      Name and Title (type or print)

                                 Printed by authority of the State of Illinois. January 2015 - 1 - C 224.10