Kane Co., IL: Supplementary Certificate of Ownership of Business

STATE OF ILLINOIS
County of Kane

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Certificate No.

SUPPLEMENTARY CERTIFICATE OF OWNERSHIP OF BUSINESS

On the date of , the original certificate of ownership was filed in the office of the County Clerk for:
	NAME OF BUSINESS
The following changes are now indicated:

Addition of person(s) name	Withdrawal of person(s) name
Change of Address	Closing business

Please specify:

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STATE OF ILLINOIS
County of Kane

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___________________________________________________, being duly sworn, upon oath deposes and says that the foregoing is a true and correct supplementary report of the person or persons who have ceased doing business in the above-named firm, together with their home addresses, or a change of addres of the business.

	____________________________________ Signature of Informant
Subscribed and sowrn to before me this date: ______________________________________________

(notary seal)

____________________________________
Signature of Notary Public

NOTE: When withdrawal or addition effectuates change or transfer of 25% or more of total ownership, notice of filing Supplementary Certificate must be published.