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Statement Of Change Of Registered Office By Agent Form - Corporation Bureau Pennsylvania Department Of State Page 3

DSCB:15-108-3

Department of State

Corporation Bureau

P.O. Box 8722

Harrisburg, PA 17105-8722

(717) 787-1057

Web site:

Instructions for Completion of Form:

A. Typewritten is preferred. If not, the form shall be completed in black or blue-black ink in order to permit

reproduction. The filing fee for this form is $5 made payable to the Department of State.

B. Under 15 Pa.C.S. § 135(c) (relating to addresses) an actual street or rural route box number must be used as an

address, and the Department of State is required to refuse to receive or file any document that sets forth only a post

office box address.

C. This form is to be signed on behalf of the agent named in Paragraph 2, not by an officer of the association named in

Paragraph 1. The term “name of the person in care of the office” in Paragraph 4 refers to the proper name of the

corporation service company/agent/registered office provider.

D. A separate form DSCB:15-108 shall be filed for each association represented by the agent named in Paragraph 4.

E. The agent is required by 15 Pa.C.S. § 108(b) (relating to action by and notice to association) to furnish to the

association a copy of this form as filed in the Department.

F. Under 15 Pa.C.S. § 108(a) (relating to general rule), if the status of an agent as a provider of a registered office is

terminated by this filing, the location of the registered office of the association represented is not affected, but the

person formerly in care of the office (e.g. corporation service company/agent/registered office provider) shall

thereafter not have any responsibility with respect to matters tendered to the office in the name of the association

represented. The association should immediately file in the Department an appropriate form designating a

superseding registered office address. Until this occurs, the old address is continued in effect for purposes of

venue and official publication.

G. This form and all accompanying documents shall be mailed to the address stated above.

Statement Of Change Of Registered Office By Agent Form - Corporation Bureau Pennsylvania Department Of State Page 3