Form BCA-1.17 "Petition for Refund or Review" - Illinois

What Is Form BCA-1.17?

This is a legal form that was released by the Illinois Secretary of State - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2014;
  • The latest edition provided by the Illinois Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BCA-1.17 by clicking the link below or browse more documents and templates provided by the Illinois Secretary of State.

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Download Form BCA-1.17 "Petition for Refund or Review" - Illinois

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BCA-1.17
FORM
(rev. Dec. 2014)
Petition for Refund or Review
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: $5
File #: ___________________________
Approved: ______________________
________ Submit in duplicate ________ Type or Print clearly in black ink ________ Do not write above this line ________
11. Corporate Name: _______________________________________________________________________________
12. State or Country of Incorporation: __________________________________________________________________
13. Nature of Claim:
Refund
Adjustment of Assessment
(Mark an “X” in one box only.)
14. Amount of Claim: $________________________________
• No refund will be made from an overpayment of less than $200.
• Any amount to be refunded will be reduced by $200.
• The $200 restrictions DO NOT apply to adjustments of assessments.
15. Reason for Claim and Facts Relied Upon:
(For more space, use reverse side or attach additional sheets of this size.)
16. 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.
Dated _______________________________ , _____
________________________________________________
Month Day
Year
Exact Name of Corporation
by
______________________________________
Any Authorized Officer’s Signature
______________________________________
Name and Title (type or print)
Printed by authority of the State of Illinois. January 2015 — 1 — C 198.9
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BCA-1.17
FORM
(rev. Dec. 2014)
Petition for Refund or Review
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: $5
File #: ___________________________
Approved: ______________________
________ Submit in duplicate ________ Type or Print clearly in black ink ________ Do not write above this line ________
11. Corporate Name: _______________________________________________________________________________
12. State or Country of Incorporation: __________________________________________________________________
13. Nature of Claim:
Refund
Adjustment of Assessment
(Mark an “X” in one box only.)
14. Amount of Claim: $________________________________
• No refund will be made from an overpayment of less than $200.
• Any amount to be refunded will be reduced by $200.
• The $200 restrictions DO NOT apply to adjustments of assessments.
15. Reason for Claim and Facts Relied Upon:
(For more space, use reverse side or attach additional sheets of this size.)
16. 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.
Dated _______________________________ , _____
________________________________________________
Month Day
Year
Exact Name of Corporation
by
______________________________________
Any Authorized Officer’s Signature
______________________________________
Name and Title (type or print)
Printed by authority of the State of Illinois. January 2015 — 1 — C 198.9