PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Name Address City State Zip Code Copy/Certification Request DSCB:15-133/145/153 (7/1/2015) *13353* 13353 Return document by email to: _________________________________ Read all instructions prior to completing. Copies and certifications of most filed documents may be obtained online at https://www.corporations.pa.gov/. 1. The requested entity name(s) and number(s), if known, is(are): Name Entity Number Name Entity Number Name Entity Number Name 2. The document and quantity requested is: ____ Subsistence Certificate (for domestic entity) ____ Certificate of Registration (for registered foreign association) Entity Number ____ Engrossed Certificate (custom certification) attesting to:________________________________________________ ____ Plain or ____ Certified Index and Docket report (written search) ____ Plain or ____ Certified copies of all documents on record for the above identified entity(ies) ____ Plain or ____ Certified copies of _________________________________________________________________ Indicate specific documents requested for the above identified entity(ies) 3. Method of payment: ____ Check/money order Deposit Account Number _____________________ American LegalNet, Inc. www.FormsWorkFlow.com DSCB: 15-133/145/153­Instructions 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 General Information Typewritten is preferred. If not typed, the form must be legible and completed in black or blue-black ink in order to permit reproduction. The fees vary based on the document requested and number of pages. The statutory fees are available on the Bureau's web site at www.dos.pa.gov/corps and in statute at 15 Pa.C.S. § 153 and are identified below. Statutes are available on the Pennsylvania General Assembly website, www.legis.state.pa.us, by following the link for Statutes. Checks should be made payable to the Department of State and must contain a commercially pre-printed name and address. The requestor agrees to pay all statutory fees with respect to this request in advance of receiving the information and/or documents. If the total fee is unable to be calculated, the initial search fee of $15 (per entity name) must be received before the Bureau will begin processing the request. If the fee cannot be calculated in advance or if insufficient funds are submitted, the Bureau will return an invoice indicating additional fees due. All fees must be paid prior to the Bureau releasing the requested documents. Expedited Service of copy and certification requests may be obtained by submitting DSCB:15-153(a)(15) (Expedited Service Request), together with this form and required fees. This form and payment should be mailed or delivered to the address above. Form Instructions Enter the name and mailing address to which any correspondence regarding this request should be sent. This field must be completed for the Bureau to return the requested copies. If the copies/certifications are 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 the requested document may be downloaded. 1. Give the entity name(s) and the entity number, if known, for which information is being requested. Up to four entities may be listed per form. 2. Give the quantity of documents requested, and if applicable, identify the specific documents or information requested (i.e. Articles of Incorporation, Statement of Merger etc.) Multiple documents may be selected on one form. 3. Check the appropriate payment type and provide the customer deposit account number, if applicable. 4. Check the appropriate method of expedited service, if applicable. Expedited fees are in addition to the statutory fees for the requested documents. Expedited fees are per document and/or entity requested. Expedited requests must be submitted to the Bureau in person. Fees Subsistence Certificate Certificate of Registration Engrossed Certificate Certification Search Fee Copy Fee (per page furnished) Certified Index and Docket Plain Index and Docket $ 40.00 $ 40.00 $125.00 $ 40.00 $ 15.00 $ 3.00 $ 55.00 $ 15.00 American LegalNet, Inc. www.FormsWorkFlow.com