Form Dscb:54-312/313-2 - Fictitious Name Amendment, Withdrawal, Cancellation printable pdf download

Form Dscb:54-312/313-2 - Fictitious Name Amendment, Withdrawal, Cancellation

PENNSYLVANIA DEPARTMENT OF STATE

CORPORATION BUREAU

Fictitious Name

Amendment, Withdrawal, Cancellation

(54 Pa.C.S.)

Amendment (§ 312)

Withdrawal (§ 313)

Cancellation (§ 313)

Name

Document will be returned to the

name and address you enter to

the left.

Address

City

State

Zip Code

Fee: $70

In compliance with the requirements of 54 Pa.C.S. Ch.3 (relating to fictitious names), the undersigned entity or entities,

desiring to amend, withdraw or cancel from a fictitious name registration, hereby state(s) that:

. The fictitious name is:

2. The address of the principal place of business, including number and street, if any, is (the Department is

authorized to conform to the records of the Department):

Number and street

City

State

Zip

County

3. The last preceding filing with respect to this fictitious name was made in the Department on

(Date) at

(Roll and Film).

4. A brief statement of the character or nature of the business or other activity to be carried on under or through

the fictitious name is:

Form Dscb:54-312/313-2 - Fictitious Name Amendment, Withdrawal, Cancellation