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.
Fee: $70
In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 8832 (relating to certificate of
authority), the undersigned limited liability company, desiring to effect a certificate of authority (or amendment or
cancellation thereto) hereby states that:
I. Required fields for Certificate, Amendment or Cancellation
1. The name of the limited liability company is:
_________________________________________________________
2. The current registered office address as on file with the Department of State. Complete part (a) OR (b) – not both:
(a) _______________________________________________________________________________________________
Number and street
City
State
Zip
County
(b) c/o: ____________________________________________________________________________________________
Name of Commercial Registered Office Provider
County
II. Certificate of Company Authority Only
1. All persons holding the following position (e.g., Managing Member, Manager) _________________________
with respect to the company has the authority to do the following: Check all that apply. For additional positions,
attach additional pages as needed.
Sign an instrument transferring real property held in the name of the company. Other specification or
limitation may be provided. Additional pages may be attached as needed.
__________________________________________________________________________________________
__________________________________________________________________________________________
Enter into other transactions on behalf of, or otherwise act for or bind, the company. Other specification
or limitation may be provided. Additional pages may be attached as needed.
__________________________________________________________________________________________
__________________________________________________________________________________________