Form Dscb:15-412 - Foreign Registration Statement Template - Pennsylvania Department Of State Bureau Of Corporations And Charitable Organizations

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PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Foreign Registration Statement
DSCB:15-412
Name
(7/1/2015)
Address
*412*
City
State
Zip Code
412
Return document by email to:
_________________________________
Fee: $250
In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 412 (relating to foreign
registration statement), the undersigned foreign association hereby states that:
1. The type of association is (check only one):
Business Corporation
Limited Partnership
Business Trust
Nonprofit Corporation
Limited Liability (General) Partnership
Professional Association
Limited Liability Company
Limited Liability Limited Partnership
2. The full and proper name of the foreign association as registered in its jurisdiction of formation is:
2A. If the name in 2 does not contain a required designator or if the name in 2 is not available for use in the
Commonwealth, the alternate name under which the association is registering in this Commonwealth is:
A resolution of the governors adopting the name in 2A for use in registering to do business in this Commonwealth must be attached.
3. The jurisdiction of formation is: _____________________________________________________________________
4. The street and mailing address of the association’s principal office.
____________________________________________________________________________________________________________
Number and street
City
State
Zip
4A. The street and mailing address of the office, if any, required to be maintained by the law of the association’s
jurisdiction of formation in that jurisdiction:
____________________________________________________________________________________________________________
Number and street
City
State
Zip

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