Statement Of Correction - Commonwealth Of Pennsylvania

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Microfilm Number
Filed with the Department of State on_________
Entity Number
____________________________________
Secretary of the Commonwealth
STATEMENT OF CORRECTION
DSCB:15-138 (Rev 90)
In compliance with the requirements of 15 Pa.C.S. § 138 (relating to statement of correction) the undersigned association
or other person, desiring to correct an inaccurate record of corporate or other action or correct defective or erroneous execution
of a document, hereby states that:
1. The name of the association or other person is:
____________________________________________________________________________________________________
2. The (a) address of this association's current registered office in this Commonwealth or (b) name of its commercial registered
office provider and the county of venue is (the Department is hereby authorized to correct the following information to
conform to the records of the Department):
(a) _____________________________________________________________________________________
Number and Street
City
State
Zip
County
(b) c/o: __________________________________________________________________________________
Name of Commercial Registered Office Provider County
For an association represented by a commercial registered office provider, the county in (b) shall be deemed the county in which the
association is located for venue and official publication purposes.
3. The statute by or under which it was incorporated or the preceding filing was made, in the case of a filing that does not
constitute a part of the articles of incorporation of a corporation, is:
4. The inaccuracy or defect, which appears in Department of State form
filed on
and recorded
in Roll and Film Number
et seq., is:
5. (Check one of the following):
The portion of the document requiring correction in corrected form is set forth in Exhibit A attached hereto and ma de a part
hereof.
The original document to which this statement relates shall be deemed reexecuted.
The original document to which this statement relates shall be deemed stricken from the records of the Department.
IN TESTIMONY WHEREOF, the undersigned association or other person has caused this statement to be signed by a duly
authorized officer thereof or otherwise in its name this
day of
,
.
_____________________________________________
(Name)
BY:__________________________________________
(Signature)
TITLE:________________________________________

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