PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Name Reservation/Transfer of Reservation
DSCB:15-208
Name
(7/1/2015)
Address
*208*
City
State
Zip Code
208
Return document by email to:
_________________________________
Read all instructions prior to completing. This form may be submitted online at https://
Fee: $70
Check One:
Name Reservation
Transfer of Name Reservation
In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 208 (relating to Reservation of
name), the undersigned hereby states that:
1. The name to be reserved/transferred is: _______________________________________________________________
2. The name of the person or association reserving/transferring the name is:
__________________________________________________________________________________________________
3. The address of the person or association reserving/transferring the name is:
___________________________________________________________________________________________________________
Number and street
City
State
Zip Code
For TRANSFER of Name Reservation ONLY
4. The name of the person or association to whom the name reservation is being transferred is:
__________________________________________________________________________________________________
5. The address of the person or association to whom the name reservation is being transferred is:
__________________________________________________________________________________________________________
Number and street
City
State
Zip Code
IN TESTIMONY WHEREOF, the undersigned person or association has caused this Name Reservation/Transfer of
Reservation to be signed this ______________ day of ____________________________, 20________.
___________________________________________________
Name of Applicant/Transferor*
___________________________________________________
Applicant/Duly authorized representative/Transferor Signature
(A transfer of name reservation must be signed by
the person who initially reserved the name.)
___________________________________________________
Title (for association applicant only)