Form Dscb:15-162a - Statement Of Contingent Domestication-Foreign Business Corporation

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Microfilm Number
Filed with the Department of State on_______________
Entity Number_____________________
______________________________________________
Secretary of the Commonwealth
STATEMENT OF CONTINGENT DOMESTICATION-FOREIGN BUSINESS CORPORATION
DSCB:15-162A (Rev 90)
In compliance with the requirements of 15 Pa.C.S. § 162 (relating to contingent domestication of certain foreign associations),
the undersigned foreign business corporation, desiring to become a contingent domestic association, hereby states that:
1.
The name of the corporation is:___________________________________________________________________________
____________________________________________________________________________________________________
2. The (a) address of this corporation's current registered office in this Commonwealth or (b) name of its commercial registered
office provider and the county of venue is (the Department is hereby authorized to correct the following information to
conform to the records of the Department):
(a)_______________________________________________________________________________________________
Number and Street
City
State
Zip
County
(b) c/o:____________________________________________________________________________________________
Name of Commercial Registered Office Provider
County
For a corporation represented by a commercial registered office provider, the county in (b) shall be deemed the county in which the
corporation is located for venue and official publication purposes.
3. Upon domestication the corporation will be subject to the domestic corporation provisions of the Business Corporation Law of
1988.
4. (Strike out if inapplicable; otherwise check and, if applicable, complete one or more of the following):
The purpose or purposes for which the corporation is to be domesticated in the Commonwealth of Pennsylvania are:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
The purposes for which the corporation is to be domesticated in the Commonwealth of Pennsylvania include unlimited
power to engage in and to do any lawful act concerning any and all lawful business for which corporations may be
incorporated under the Business Corporation Law of 1988.
The purposes for which the corporation is to be domesticated in the Commonwealth of Pennsylvania consist of unlimited
power to engage in and to do any lawful act concerning any and all lawful business for which corporations may be
incorporated under the Business Corporation Law of 1988.
5. (Strike out if inapplicable): This Statement of Contingent Domestication includes the additional provisions set forth in Exhibit
A attached hereto and made a part hereof.
6. The effectiveness of this Statement of Contingent Domestication is contingent upon the subsequent filing of a Statement
of Consummation of Domestication.
7. The filing of this Statement of Contingent Domestication and the delegation of authority to file a Statement of
Consummation of Domestication on behalf of the undersigned corporation has been authorized by a majority vote of the
votes cast by all shareholders entitled to vote thereon and, if any class of shares is entitled to vote thereon as a class, a
majority of the votes cast in each class vote, or by any greater vote required by its charter.

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