Form Dscb:15-418 - Transfer Of Foreign Registration Page 2
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4DSCB:15-418 - 2
If different than the information for the registered foreign association before the merger or conversion, all of the
following information for the association after the merger or conversion:
6A. The street and mailing address of the association’s principal office is:
____________________________________________________________________________________________________________
Number and street
City
State
Zip
6B. The street and mailing address of the office, if any, required to be maintained by the law of the association’s
jurisdiction of formation in that jurisdiction is:
____________________________________________________________________________________________________________
Number and street
City
State
Zip
7. The (a) address of the association’s registered office in this Commonwealth or (b) name of its Commercial Registered
Office Provider and the county of venue is:
Complete part (a) OR (b) – not both:
(a) ________________________________________________________________________________________________________
Number and street
City
State
Zip
County
OR
(b) c/o: _____________________________________________________________________________________________________
Name of Commercial Registered Office Provider
County
8. Effective date of transfer of foreign registration is (check, and if appropriate complete, one of the following):
The Transfer of Foreign Registration shall be effective upon filing in the Department of State.
The Transfer of Foreign Registration shall be effective on: _________________________ at __________________.
Date (MM/DD/YYYY)
Hour (if any)
IN TESTIMONY WHEREOF, the undersigned registered foreign association has caused this Transfer of Foreign
Registration to be signed by a duly authorized representative of the surviving or converted association this
__________ day of _________________________20_____ __.
______________________________________
Name of Association
___________________________________________________
Signature
___________________________________________________
Title
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