Statement Of Summary Of Record Form. This is a Pennsylvania form and can be use in Domestic Business Corporation Department Of State.
Tags: Statement Of Summary Of Record, DSCB 15-1311, Pennsylvania Department Of State, Domestic Business Corporation
PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Name Address City State Zip Code Statement of Summary of Record DSCB:15-1311/5311/9305 (rev. 7/2015) *131135* 131135 Return document by email to: _________________________________ Read all instructions prior to completing. Fee: $70 Check one: Business Corporation (§ 1311) Nonprofit Corporation (§ 5311) Professional Association (§ 9305) In compliance with the requirements of the applicable provisions of 15 Pa.C.S. (relating to corporations and unincorporated associations) the undersigned association hereby states that: 1. The name of the association is: 2. The (a) address of this association's current registered office in this Commonwealth or (b) name of its commercial registered office provider and the county of venue is: (Complete only (a) or (b), not both) (a) Number and Street City State Zip County (b) Name of Commercial Registered Office Provider c/o: County 3. The statute by or under which it was incorporated or formed is: ______________________________ 4. The association was originally incorporated or formed on under the following name: Date (MM/DD/YYYY) American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-1311/5311/9305 5. Check and complete one of the following: The association was incorporated or formed by Special act as set forth in Paragraph 3 above. Decree of: Name of Court entered on: Date (MM/DD/YYYY) . Letters patent duly granted on: Date (MM/DD/YYYY) . in the: . Name of Department or other public office Filing of: Articles of Incorporation, etc. 6. The original Articles were recorded on Date (MM/DD/YYYY) in the following place 7. Check, and if appropriate complete, one of the following: This certificate is being delivered to the Department of State contemporaneously with an amended and restated Articles of the association as set forth in Exhibit A attached hereto and made a part hereof. The currently effective Articles of the association are filed or recorded as follows and the text of such currently effective Articles is set forth in Exhibit A attached hereto and made a part hereof (except any of such text which appears of record in the Department of State, which text is incorporated herein by reference to the records of the Department pursuant to 19 Pa. Code § 13.6 (relating to incorporation by reference)): _____________________________________________________________________________________ Recorder of Deeds book and page numbers, etc. Amended and restated Articles of the association which include all the information required to be set forth in the Articles of a Professional Corporation are set forth in Exhibit A attached hereto and made a part hereof. 8. Check, and if appropriate, complete one of the following: The association has never adopted any name other than its original name and its current name. Each name by which the association was known, other than its original name and its current name, and the date or dates on which each change of name of the association became effective, are as follows: Name Effective Date of Adoption American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-1311/5311/9305-3 IN TESTIMONY WHEREOF, the undersigned association has caused this Statement of Summary of Record to be signed by a duly authorized officer thereof this day of , . Name of Association Signature Title American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-1311/5311/9305- Instructions Pennsylvania Department of State Bureau of Corporations and Charitable Organizations P.O. Box 8722 Harrisburg, PA 17105-8722 (717) 787-1057 web site: www.dos.pa.gov/corps Instructions for Completion of Form: A. Typewritten is preferred. If handwritten, the form shall be legible and completed in black or blue-black ink in order to permit reproduction. The nonrefundable filing fee for this form, if applicable (see instruction C below), is $70 made payable to the Department of State. Checks must contain a commercially pre-printed name and address. 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. B. Under 15 Pa.C.S. § 135(c) (relating to addresses) an actual street or rural route box number must be used as an address, and the Department of State is required to refuse to receive or file any document that sets forth only a post office box address. C. When this form accompanies another filing, e.g., articles of amendment, it will be deemed for filing fee and docketing statement purposes to be incorporated by reference into the filing to which it relates, and no separate filing fee shall be submitted. Otherwise, the following, in addition to the filing fee, shall accompany this form: one copy of a completed form DSCB:15-134A (Docketing Statement). D. Set forth in Paragraph 6 the place or places, including volume and page numbers of their equivalent where the original Articles were filed or recorded. This information may be omitted if the first alternate of Paragraph 5 is applicable. E. The first alternate of Paragraph 7 is applicable to a non-surviving party to a plan of merger which restates the Articles of the surviving corporation and to any corporation which is a party to a plan of consolidation. F. Set forth in the second alternate of Paragraph 7 the place or places, including volume and page numbers or their equivalent, where the documents are filed or recorded, and the date or dates of each such filing or recording. Text which appears of record in the Department of State, may be incorporated by reference in this form to the records of the Department. This instruction is an exception to the general rule against incorporation by reference contemplated by 19 Pa. Code § 13.6 (relating to incorporation by reference). G. The third alternate of Paragraph 7 is applicable only when this form is submitted with form DSCB:15-2905 (Statement of Election of Professional Corporation Status). H. Include a clear and legible copy of the original Articles of Incorporation and all amendments, or restate the articles in their entiret