Application For Registration Of Fictitious Name Form - Pennsylvania Department Of State Corporation Bureau

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PENNSYLVANIA DEPARTMENT OF STATE
CORPORATION BUREAU
Application for Registration of Fictitious Name
54 Pa.C.S. § 311
Document will be returned to the
Name
name and address you enter to
the left.
⇐
Address
City
State
Zip Code
Fee: $70
In compliance with the requirements of 54 Pa.C.S. § 311 (relating to registration), the undersigned entity(ies) desiring to register a
fictitious name under 54 Pa.C.S. Ch. 3 (relating to fictitious names), hereby state(s) that:
The fictitious name is:
1.
2. A brief statement of the character or nature of the business or other activity to be carried on under or through
the fictitious name is:
.
3
The address, including number and street, if any, of the principal place of business (P.O. Box alone is not
acceptable):
Number and street
City
State
Zip
County
4. The name and address, including number and street, if any, of each individual interested in the business is:
Z
Name
Number and Street
City
State

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