Docketing Statement (Changes)
Docketing Statement (Changes) Form. This is a Pennsylvania form and can be use in Docketing Statements Department Of State.
Tags: Docketing Statement (Changes), DSCB 15-134B, Pennsylvania Department Of State, Docketing Statements
Docketing Statement (Changes) DSCB:15-134B BUREAU USE ONLY: Revenue Labor & Industry Other _____________________ File Code_________ Filed Date ____________ Part I. Complete for each filing: Current name of entity or registrant (survivor or new entity if merger or consolidation): Entity number, if known: State of Inc: Incorporation/qualification date in PA: Federal EIN: Specified effective date, if any: Part II. Check proper box: Amendment (complete Section A) Merger, Consolidation or Division (complete Section B,C or D) Consolidation (complete Section C) Division (complete Section D) Conversion (complete Section A & E) Correction (complete Section A) Termination (complete Section H) Revival (complete Section G) Dissolution before Commencement of Business (complete Section F) Section A – Check box(es) which pertain to changes: Name: Registered Office: Number & street/RD number & box number City State Zip County Purpose: Stock (aggregate number of share authorized): Effective date: Term of Existence: Other: . . Section B – Merger Complete Section A if any changes to surviving entity: Merging Entities are: (attach sheet for additional merging entities) DSCB:15-134B-2 Name: DSCB:15-134B-2 Effective date: Entity #, if known: Inc./qual. date in PA. Name: Effective date: State of Inc. Entity #, if known: Inc./qual. date in PA. State of Inc. 2002 © American LegalNet, Inc. Section C - Consolidation Consolidating Entities are: (attach sheet for additional consolidating entities) Name: Entity #, if known: Inc./qual. date in PA. State of Inc. Inc./qual. date in PA. State of Inc. Name: Entity #, if known: Section D – Division Forming new entity(s) named below: (attached sheet for additional entities) Name: Entity Number: Name: Entity Number: Check one: Entity named in Part I survives. (any changes, complete Section A) Entity named in Part I does not survive. Section E – Conversion (complete Section A) Check one: Converted from nonprofit to profit Converted from profit to nonprofit Section F – Dissolved by Shareholders or Incorporators Before Commencement of Business Section G – Statement of Revival (complete Section A for any changes to revived entity) Entity named in Part I hereby revives its charter or articles which were forfeited by Proclamation or expired. Section H – Statement of Termination (attach sheet for additional entities involved) filed in the Department of State on is/are hereby terminated. (type of filing made) month/date/year hour, if any If merger, consolidation or division, list all entities involved, other than that listed in Part I: Name: Entity number: Name: Entity number: 2002 © American LegalNet, Inc.