PENNSYLVANIA DEPARTMENT OF STATE
CORPORATION BUREAU
Statement of Contingent Domestication-Foreign
(15 Pa.C.S.)
Entity Number
Business Corporation (§ 162A)
Nonprofit Corporation (§ 162B)
Limited Partnership (§ 162C)
Limited Liability Company (§ 162D)
Name
Document will be returned to the
name and address you enter to
the left.
Address
⇐
City
State
Zip Code
Fee: $1300
Filed in the Department of State on ________________________
Secretary of the Commonwealth
In compliance with the requirements of the applicable provisions (relating to contingent domestication of certain foreign
associations), the undersigned, desiring to become a domestic association, hereby states that:
The name is:
1.
2. The (a) address of its initial 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
3. Check one of the following:
Business Corporation: Upon domestication the corporation will be subject to the domestic corporation
provisions of the Business Corporation Law of 1988.
Nonprofit Corporation: Upon domestication the corporation will be subject to the domestic corporation
provisions of the Nonprofit Corporation Law of 1988.
Limited Partnership: Upon domestication the limited partnership will be subject to the domestic limited
partnership provisions of the Limited Partnership Act of 1988.
Limited Liability Company: Upon domestication the limited liability company will be subject to the
domestic limited liability company provisions of the Limited Liability Act of 1994.