Fillable Form Dscb:15-8833 - Certificate Of Denial (Page 2 of 2) in pdf

DSCB:15-8833 – Instructions

Pennsylvania Department of State

Bureau of Corporations and Charitable Organizations

P.O. Box 8722

Harrisburg, PA 17105-8722

(717) 787-1057

Website:

General Information

Post office boxes are not acceptable for any address. Under 15

Typewritten is preferred. If handwritten, the form must be

Pa.C.S. § 135(c) (relating to addresses) an actual street or rural

legible and completed in black or blue-black ink in order to

route box number must be used as an address, and the

permit reproduction. The nonrefundable filing fee for this

Department of State is required to refuse to receive or file any

form is $70.

document that sets forth only a post office box address.

Checks should be made payable to the Department of State.

Checks must contain a commercially pre-printed name and

3. This field should give the date the Certificate of Authority

address.

to which the denial pertains was filed in the Department of

State. This field is required.

This form and all accompanying documents, including any

necessary governmental approvals, shall be mailed to the

4. Mandatory statement. This field is required.

address stated above.

Signature and Verification

Who should file this form?

A Certificate of Denial of Company Authority by a person

This form may be used by a person named in a filed

must be signed by that person.

Signing a document

Certificate of Authority pertaining to a limited liability

delivered to the Department for filing is an affirmation

company to deny such authority. The Certificate of Denial

under the penalties provided in 18 Pa.C.S. § 4904 (relating

operates as a restrictive amendment to the Certificate of

to unsworn falsification to authorities) that the facts stated

Company Authority and a certified copy may be recorded by

in the document are true in all material respects.

This field

the company or the person that delivered the Certificate of

is required.

Denial to the Department of State for filing. The Certificate of

Denial affects only the authority of a person to bind a

company with respect to persons that are not partners.

Applicable Law

For relations of members and managers to persons dealing

with limited liability company, in general, see 15 Pa.C.S.

§§ 8831-8835. Statutes are available on the Pennsylvania

General Assembly website, , by

following the link for Statutes.

Form Instructions

Enter the name and mailing address to which any

correspondence regarding this filing should be sent.

This field must be completed for the Bureau to return the

filing. If the filing is to be returned by email, an email address

must be provided. An email will be sent to address provided,

containing a link and instructions on how a copy of the filed

document or correspondence may be downloaded. Any email

or mailing addresses provided on this form will become part

of the filed document and therefore public record.

1. Give the exact name of the limited liability company. The

name on this line must match exactly the company name as on

file with the Department at the time the Certificate of Denial

of Company Authority is submitted for filing. This field is

required.

2. Current address. The address provided must be the

company’s registered office address on file with the

Department of State at the time the Certificate of Denial of

Company Authority is submitted for filing. This field is

required.

Form Dscb:15-8833 - Certificate Of Denial Page 2

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