Form Dscb:15-1971/5971 - Voluntary Dissolution - Never Transacted Business
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3PENNSYLVANIA 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 form may be submitted online at https://
Fee: $70
Check one:
By Shareholders or Incorporators - Domestic Business Corporation (§ 1971)
By Members or Incorporators - Domestic Nonprofit Corporation (§ 5971)
In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 1971 or § 5971 (relating to
voluntary dissolution by shareholders, incorporators or members for a corporation that has never transacted business), the
undersigned, desiring that the corporation should be dissolved, hereby states that:
1. The name of the corporation is: __________________________________________________________________
2. The current registered office address of the corporation 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
3. The statute by or under which it was incorporated: __________________________________________________
4. The date of its incorporation: ___________________________
(MM/DD/YYYY)
5. Check one of the following:
Business Corporation Only: The corporation has never transacted business or held assets other than money
received from subscriptions for shares.
Nonprofit Corporation Only: The corporation has not received any property in trust or otherwise commenced
business.
6. The amount, if any, actually paid in on subscriptions for its shares or memberships, less any part thereof disbursed for
necessary expenses, has been returned to those entitled thereto.
7. Check one of the following:
All liabilities of the corporation have been discharged.
Adequate provision has been made for the payment of the liabilities of the corporation.
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