Application For Certificate Of Authority - Pennsylvania Bureau Of Corporations And Charitable Organizations Page 2

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DSCB:15-4124/6124-2
6. The (a) address of this corporation’s proposed registered office in this Commonwealth or (b) name of its
commercial registered office provider and the county of venue is:
(a) Number and street
City
State
Zip
County
(b) Name of Commercial Registered Office Provider
County
c/o:
7. Check one of the following:
Business Corporation: The corporation is a corporation incorporated for a purpose or purposes involving
pecuniary profit, incidental or otherwise.
Nonprofit Corporation: The corporation is a corporation incorporated for a purpose or purposes not
involving pecuniary profit, incidental or otherwise.
IN TESTIMONY WHEREOF, the undersigned
corporation has caused this Application for Certificate of
Authority to be signed by a duly authorized officer thereof
this
day of
,
.
Name of Corporation
Signature
Title

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