Transcription of 15-134B Docketing statement changes
1 PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Part I. Complete for each filing: Current name of entity or association (survivor or new entity): Entity number, if known: _____ Formation/foreign registration date in PA: _____ State of formation: _____ Effective date, if any: _____ Part II. Check appropriate transaction: ____ Amendment (complete Section A) ____ Correction (complete Section A) ____ Merger (complete Section B) ____ Division (complete Section C) ____ Conversion (complete Sections A and D) ____ Abandonment (complete Section E) ____ Revival (complete Section F) ____ Domestication (complete Section G) ____ Dissolution before Commencement of Business (complete Section H) Section A Amendment or Correction - Complete fields which pertain to changes : Name_____ Registered Office.
2 _____ Number and street City State Zip County Purpose _____ Stock (aggregate number of shares authorized): _____ Effective Date: _____ Term of Existence: _____ Other: _____ Filing type to be amended or corrected: _____ Section B Merger - Complete Section A with any changes to the association surviving the merger, if any Merging entities not surviving the merger are: (attach sheet for additional merging entities) _____ Name _____ Effective Date Incorporation/foreign registration date in PA State of Jurisdiction _____ Name _____ Effective Date Incorporation/ foreign registration date in PA State of Jurisdiction BUREAU USE ONLY.
3 Revenue ____ Labor & Industry ____ Other _____ Filed Date _____ Docketing statement changes DSCB: 15-134B (rev. 7/1/2015) DSCB: 15-134B -2 Section C Division - Complete Section A with any changes to the association surviving the division, if any Check only one: ____ Entity named in Part I survives ___ Entity named in Part I does not survive.
4 Newly created entity(s) from the division are: (attach sheet for additional new entities) _____ Name Entity Number _____ Name Entity Number Section D Conversion Type of converting association (check only one): Type of converted association (check only one): ___ Business Corporation ___ Business Corporation ___ Nonprofit Corporation ___ Nonprofit Corporation ___ General Partnership ___ General Partnership ___ Limited Partnership
5 ___ Limited Partnership ___ Limited Liability (General) Partnership ___ Limited Liability (General) Partnership ___ Limited Liability Limited Partnership ___ Limited Liability Limited Partnership ___ Limited Liability Company ___ Limited Liability Company ___ Professional Association ___ Professional Association ___ Business Trust/Common Law Trust/Statutory Trust ___ Business Trust/Common Law Trust/Statutory Trust ___ Other _____ ___ Other _____ Jurisdiction _____ Jurisdiction _____ Section E
6 Abandonment _____ filed in the Department of State on _____ Type of filing Date of filing Identify all entities involved (attach sheet for additional entities) _____ Name Entity Number _____ Name Entity Number Section F Revival - complete Section A with any changes to revived association ___ Entity named in Part I hereby revives its charter or articles which were forfeited by Proclamation or expired. Section G Domestication Domesticating jurisdiction _____ Domesticated jurisdiction _____ Check if applicable ___ Domesticated entity is a nonregistered foreign association Section H Dissolution before Commencement of Business ___ Entity named in Part I hereby dissolves prior to the commencement of business.
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