Form Dscb:15-162a/162b/162c/162d-2 - Statement Of Contingent Domestication-Foreign - 2002 Page 2

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DSCB:15-162A/162B/162C/162D-2
Foreign Nonprofit, Limited Partnership and Limited Liability Company: complete paragraph 4
4. The purpose or purposes to be domesticated in the Commonwealth of Pennsylvania are:
Foreign Business Corporation: complete paragraph 5
5. (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 is/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.
Strike out if inapplicable: This Statement of Contingent Domestication includes the additional provisions set
6.
forth in Exhibit A attached hereto and made a part hereof.
7. The effectiveness of this Statement of Contingent Domestication is contingent upon the subsequent filing of a
Statement of Consummation of Domestication.
8. 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, has been authorized by a majority vote of the
votes cast by all members/partners/shareholders, if any, entitled to vote thereon and, if any class of
members/partners/shares is entitled to vote thereon as a class, a majority of the votes cast in each class
vote subject to § 8982 or § 8590 or by any greater vote required by its charter.
IN TESTIMONY WHEREOF, the undersigned has caused
this statement to be executed this
day of
,
.
Name of Corporation/Limited Partnership/Limited
Liability Company
Signature
Title

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