PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Decennial Report
of Association Continued Existence
Name
DSCB:54-503 (rev. 7/2015
Address
*503*
City
State
Zip Code
503
Return document by email to:
________________________________
Read all instructions prior to completing.
Fee: $70
In compliance with the requirements of 54 Pa.C.S. § 503 (relating to decennial filings required) the undersigned
association hereby states that:
1. The name of the association to which this report relates is:
________________________________________________________________________________________
2. The address of this association’s current registered office in the Commonwealth or name of its commercial
registered office provider and the county of venue is:
_________________________________________________________________________________________
Number and Street/Commercial Registered Office Provider
City
State
Zip
County
3. Complete part A or B if applicable:
A. The address to which the registered office of the association in this Commonwealth is to be changed to:
__________________________________________________________________________________________
Number and Street
City
State
Zip
County
B. The registered office of the association shall be provided by:
___________________________________________________________________________________________
Name of Commercial Registered Office Provider
County
4. The association has not made any filing in the Department from January 1, 2002 through December 31, 2011, in
accordance with 54 Pa.C.S. § 503(b).
5. The Association continues to exist.
IN TESTIMONY WHEREOF, the undersigned association has caused this Decennial Report of Association
Continued Existence to be signed by a duly authorized officer this _______ day of _________________, 20_______.
_______________________________________________________
Name of Association
_______________________________________________________
Signature
_______________________________________________________
Title