Form Dscb:15-209 - Application For Registration Of Name Of Nonregistered Foreign Association

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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 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 the applicable provisions of 15 Pa.C.S. § 209 (relating to registration of
name of nonregistered foreign association), the undersigned foreign association, hereby states that:
1. The type of association is (check only one):
Business Corporation
Limited Partnership
Business Trust
Nonprofit Corporation
Limited Liability (General) Partnership
Professional Association
Limited Liability Company
Limited Liability Limited Partnership
Other _________________
2. The full and proper name of the foreign association as registered in its jurisdiction of formation is:
2A. If the name in 2 does not contain a required designator or if the name in 2 is not available for use in the
Commonwealth, the alternate name under which the association is registering in this Commonwealth is:
3. The principal office address of the nonregistered foreign association is:
___________________________________________________________________________________________________________
Number and street
City
State
Zip
IN TESTIMONY WHEREOF, the undersigned nonregistered foreign association has caused this Application for
Registration of Name to be signed by a duly authorized officer thereof this _______________ day of
_____________________________, 20______.
___________________________________________________
Name of Nonregistered Foreign Association
___________________________________________________
Signature
___________________________________________________
Title

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