Statement Of Change Of Registered Office By Agent Form - Corporation Bureau Pennsylvania Department Of State Page 2
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3DSCB:15-108-2
5. The new registered office address in this Commonwealth of the above-named association represented is:
Number and street
City
State
Zip
County
For termination of status as provider of the registered office
6. ___The status of the agent as provider of the registered office of the above-named association has been
terminated.
7. The last known address above-named association represented is:
Number and street
City
State
Zip
County
IN TESTIMONY WHEREOF, the undersigned person has
caused this Statement of Change of Registered Office by
Agent to be signed this
day of
,
.
Name
Signature
Title
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