Annual Statement-Nonprofit Corporation Form

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PENNSYLVANIA DEPARTMENT OF STATE
CORPORATION BUREAU
Annual Statement-Nonprofit Corporation
Entity Number
(15 Pa.C.S. § 5110)
Document will be returned to the
Name
name and address you enter to
the left.
Address
City
State
Zip Code
Fee: None
Filed in the Department of State on
__________________________
Secretary of the Commonwealth
In compliance with the requirements of 15 Pa.C.S. § 5110 (relating to annual report), the undersigned domestic or qualified
foreign nonprofit corporation, hereby states that:
1. The name of the corporation is:
2
The address of its principal office is:
.
Number and street
City
State
Zip
County
3. The names and title of the persons who are its principal officers are:
Names
Titles
IN TESTIMONY WHEREOF, the undersigned corporation has caused this Annual Statement to be signed by a
duly authorized officer thereof this
day of
,
.
____________________________________________________________________________________________
Name of Corporation
Signature
___________________________________
Title

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