Form BCA 5.15 Notice of Resignation of Registered Agent - Illinois

Form BCA5.15 or the "Notice Of Resignation Of Registered Agent" is a form issued by the Illinois Secretary of State.

Download a PDF version of the Form BCA5.15 down below or find it on the Illinois Secretary of State Forms website.

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BCA 5.15
FORM
NOTICE OF RESIGNATION OF
REGISTERED AGENT
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-7808
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 ————
1. Corporation Name: ______________________________________________________________________________
2. Name and Address of Registered Agent and Registered Office as they appear on the records of the Office of the
Secretary of State:
Registered Agent: _______________________________________________________________________________
First Name
Middle Name
Last Name
Registered Office: _______________________________________________________________________________
Number
Street
Suite #
IL
Registered Office
_______________________________________________________________________________
City
ZIP Code
3. Effective date of resignation:
The agent resigns effective the 30th day after filing by the Secretary of State.
Another date not less than 30 days after the filing by the Secretary of State.
___________________________.
(See Note 1.)
Month/Day/Year
4. Address of Principal Office of Corporation known to the Registered Agent:
_____________________________________________________________________________________________
Number
Street
Suite #
_____________________________________________________________________________________________
City
State
ZIP Code
5. A copy of this notice has been sent to the principal office of the corporation at least 10 days prior to the date of its filing
with the Secretary of State.
6. The undersigned affirms, under penalties of perjury, that the facts stated herein are true and correct.
Dated _______________________________ , ______
Month Day
Year
by _________________________________________
by _________________________________________
Signature of Principal Officer (See Note 3.)
Signature of Registered Agent (See Note 2.)
by _________________________________________
by _________________________________________
Name (type or print)
Name (type or print)
NOTE: 1. Add additional time if mailing the form.
2. If registered agent is an individual, this notice shall be signed by the registered agent.
3. If registered agent is a business entity, this notice shall be signed by a principal officer, or as authorized
by the governing statute.
Printed by authority of the State of Illinois. December 2017 — 1 — C 200.13
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Reset
BCA 5.15
FORM
NOTICE OF RESIGNATION OF
REGISTERED AGENT
Business Corporation Act
Secretary of State
Department of Business Services
501 S. Second St., Rm. 350
Springfield, IL 62756
217-782-7808
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 ————
1. Corporation Name: ______________________________________________________________________________
2. Name and Address of Registered Agent and Registered Office as they appear on the records of the Office of the
Secretary of State:
Registered Agent: _______________________________________________________________________________
First Name
Middle Name
Last Name
Registered Office: _______________________________________________________________________________
Number
Street
Suite #
IL
Registered Office
_______________________________________________________________________________
City
ZIP Code
3. Effective date of resignation:
The agent resigns effective the 30th day after filing by the Secretary of State.
Another date not less than 30 days after the filing by the Secretary of State.
___________________________.
(See Note 1.)
Month/Day/Year
4. Address of Principal Office of Corporation known to the Registered Agent:
_____________________________________________________________________________________________
Number
Street
Suite #
_____________________________________________________________________________________________
City
State
ZIP Code
5. A copy of this notice has been sent to the principal office of the corporation at least 10 days prior to the date of its filing
with the Secretary of State.
6. The undersigned affirms, under penalties of perjury, that the facts stated herein are true and correct.
Dated _______________________________ , ______
Month Day
Year
by _________________________________________
by _________________________________________
Signature of Principal Officer (See Note 3.)
Signature of Registered Agent (See Note 2.)
by _________________________________________
by _________________________________________
Name (type or print)
Name (type or print)
NOTE: 1. Add additional time if mailing the form.
2. If registered agent is an individual, this notice shall be signed by the registered agent.
3. If registered agent is a business entity, this notice shall be signed by a principal officer, or as authorized
by the governing statute.
Printed by authority of the State of Illinois. December 2017 — 1 — C 200.13

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