Appendix C. OFFICIAL FORMS

DSCB form number	Form name
Title 15 forms
15-108	Statement of Change of Registered Office by Agent…Appx. 7
15-133/145/153	Copy/Certification Request…Appx. 10
15-134A	Docketing Statement—New Entity…Appx. 12
15-134B	Docketing Statement—Changes…Appx. 13
15-138	Statement of Correction…Appx. 15
15-141	Statement of Abandonment…Appx. 17
15-152(1)	Preclearance of Document…Appx. 19
15-153(a)(15)	Expedited Service Request…Appx. 20
15-153(a)(17)	Special Processing…Appx. 21
15-154	Statement of Unpaid Fee…Appx. 22
15-161	Statement of Domestication—Other…Appx. 23
15-208	Reservation of Name/Transfer of Reservation…Appx. 26
15-209	Application for Registration of Name of Nonregistered Foreign Association…Appx. 29
15-335	Statement of Merger…Appx. 32
15-335AD	Statement of Merger—Addendum…Appx. 39
15-345	Statement of Interest Exchange…Appx. 41
15-355	Statement of Conversion…Appx. 46
15-366	Statement of Division…Appx. 52
15-366AD	Statement of Division—Addendum…Appx. 59
15-375	Statement of Domestication…Appx. 61
15-412	Foreign Registration Statement…Appx. 66
15-413	Amendment of Foreign Registration Statement…Appx. 71
15-415/417	Statement of Withdrawal—Foreign Registration…Appx. 74
15-418	Transfer of Registration—Foreign…Appx. 78
15-1306/2102/ 2303/2702/2903/ 3101/3303/7102	Articles of Incorporation—For Profit…Appx. 82
15-1311/5311/9305	Statement of Summary of Record…Appx. 85
15-1341/5341	Statement of Revival—Domestic Corporation…Appx. 89
15-1507/5507/ 8506/8906	Statement or Certificate of Change of Registered Office…Appx. 92
15-1522	Statement with Respect to Shares—Domestic Business Corporation…Appx. 94
15-1902/5902	Statement of Termination—Domestic Corporation…Appx. 97
15-1915/5915	Articles of Amendment—Domestic Corporation…Appx. 99
15-1971/5971	Articles of Dissolution Before Commencement of Business—Domestic Corporation…Appx. 102
15-1977/5977	Articles of Dissolution—Domestic Corporation…Appx. 105
15-1989/5989	Articles of Involuntary Dissolution—Domestic Corporation…Appx. 109
15-2104/2305	Articles of Amendment—Domestic Business Corporation—Election of Nonstock Status/Statutory Close Status…Appx. 112
15-2309A/2309B	Domestic Business/Statutory Close Corporation—Breach or Cure of Breach of Qualifying Conditions…Appx. 115
15-2704/2904/3304	Articles of Amendment—Domestic Business Corporation—Election of Management/Professional/Benefit Corporation Status…Appx. 118
15-2905	Statement of Election of Professional Corporation Status…Appx. 121
15-3331	Annual Benefit Report…Appx. 123
15-5110	Annual Statement—Nonprofit Corporation…Appx. 127
15-5306/7102	Articles of Incorporation—Nonprofit…Appx. 129
15-7104/7105/ 7106/7107	Articles of Amendment—Election/Termination of Cooperative Corporation Status…Appx. 133
15-8201A	Statement of Registration—Domestic Registered Limited Liability Partnership…Appx. 136
15-8201B/8201C	Statement of Amendment/Termination—Domestic Registered Limited Liability Partnership…Appx. 139
15-8205	Statement of Withdrawal from Registered Limited Liability Partnership…Appx. 142
15-8221/8998	Certificate of Annual Registration…Appx. 144
15-8511	Certificate of Limited Partnership…Appx. 146
15-8512/8951	Certificate of Amendment—Limited Partnership/Limited Liability Company…Appx. 148
15-8513	Certificate of Cancellation—Limited Partnership…Appx. 151
15-8515	Certificate Pursuant to Judicial Order—Limited Partnership…Appx. 153
15-8519	Certificate of Summary of Record—Limited Partnership…Appx. 156
15-8524/8532	Certificate of Withdrawal by Partner…Appx. 159
15-8701A/8701B/ 8701C	Statement of Election/Amendment/Termination—Partnership…Appx. 161
15-8913	Certificate of Organization—Domestic Limited Liability Company…Appx. 164
15-8975	Certificate of Dissolution—Domestic Limited Liability Company…Appx. 167
15-9120	Unincorporated Nonprofit Association—Agent for Service of Process—Appointment/Amendment/Cancellation…Appx. 169
15-9120D	Unincorporated Nonprofit Association—Agent for Service of Process—Resignation of Agent…Appx. 172
19 Pa. Code forms
19-17.2	Consent to Appropriation of Name…Appx. 174
Title 54 forms
54-311	Application for Registration of Fictitious Name…Appx. 176
54-312/313	Fictitious Name—Amendment, Withdrawal, Cancellation…Appx.
54-502	Application for Registration of Unincorporated Association Name…Appx. 183
54-503	Decennial Report of Association Continued Existence…Appx. 185
54-506	Statement of Termination of Registration of Association Name…Appx. 187
54-1112	Application for Registration of Trademark or Service Mark…Appx. 189 179
54-1114/1115	Application for Renewal/Assignment of Registration of Trademark or Service Mark…Appx. 193
54-1311/1312	Registration/Amendment of Insignia…Appx. 197
54-1314/1515	Decennial Report of Insignia or Mark Used With Articles or Supplies…Appx. 200
54-1511/1512	Registration/Amendment of Mark Used with Articles or Supplies…Appx. 202
Title 13 forms
UCC1	Uniform Commercial Code—Financing Statement…Appx. 205
UCC1Ad	Uniform Commercial Code—Financing Statement Addendum…Appx. 207
UCC1AP	Uniform Commercial Code—Financing Statement Additional Party…Appx. 209
UCC3	Uniform Commercial Code—Financing Statement Amendment…Appx. 211
UCC3Ad	National Uniform Commercial Code—Financing Statement Amendment Addendum…Appx. 213
UCC3AP	Uniform Commercial Code—Financing Statement Amendment Additional Party…Appx. 215
UCC5	Information Statement…Appx. 217
UCC11	Information Request…Appx. 219

Source

The provisions of this Appendix C adopted June 12, 2015, effective July 1, 2015, 45 Pa.B. 2973.

Source

The provisions of this form DSCB:15-134B amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465. Immediately preceding text appears at serial pages (377155) to (377156).

Source

The provisions of this form DSCB:15-412 amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465. Immediately preceding text appears at serial pages (377208) to (377212).

Source

The provisions of this form DSCB:54-311 amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465. Immediately preceding text appears at serial pages (377318) to (377320).