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 registration expires on December 31 of each year
and must be renewed annually between October 1 and December 31.
Fee: $70
Check one:
Initial registration
Renewal of registration
In compliance with the requirements of 54 Pa.C.S. § 502 (b) and (d) (relating to certain additions to register), the
undersigned domestic unincorporated association, desiring to register with the Department of State the name under which
it is doing business or operating, hereby states that:
1. The name to be registered is: ________________________________________________________________
2. The address of the association is:
________________________________________________________________________________________________
Number and street
City
State
Zip
County
3. The length of time, if any, during which the name has been used by the applicant is: ____________________
IN TESTIMONY WHEREOF, the undersigned domestic unincorporated association has caused this Application for
Registration of Unincorporated Association Name to be signed by a duly authorized officer this
day of
, 20
.
___________________________________________________
Name of Domestic Unincorporated Association
___________________________________________________
Signature
___________________________________________________
Title