Form Dscb:54-311-2 - Registration Of Fictitious Name

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PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Return document by mail to:
Name
Address
City
State
Zip Code
Return document by email to:
_________________________________
Read all instructions prior to completing. This form may be submitted online at https://
Fee: $70
I qualify for a veteran/reservist-owned small business fee exemption (see instructions)
In compliance with the requirements of 54 Pa.C.S. § 311 (relating to registration), the undersigned entity(ies) desiring
to register a fictitious name under 54 Pa.C.S. Ch. 3 (relating to fictitious names), hereby state(s) that:
1. The fictitious name is:
2. 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:
3. The address, including number and street, if any, of the principal place of business (P.O. Box alone
is not acceptable):
Number and street
City
State
Zip
County
4. The name and address, including number and street, if any, of each individual interested in the
business is:
Name
Number and Street
City
State
Zip

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