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Decennial Report Of Association Continued Existence Form. This is a Pennsylvania form and can be use in Miscellaneous Department Of State.
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Tags: Decennial Report Of Association Continued Existence, DSCB 15-503, Pennsylvania Department Of State, Miscellaneous
PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Decennial Report of
Association Continued Existence
(54 Pa.C.S. § 503)
Document will be returned to the
name and address you enter to
the left.
Name
Address
City
State
Zip Code
Fee: $70
In compliance with the requirements of 54 Pa.C.S. § 503 (relating to decennial filings required) the undersigned association
hereby states that:
1. The name of the association to which this report relates is:
________________________________________________________________________________________
2. The address of this association’s current registered office in the Commonwealth or name of its commercial
registered office provider and the county of venue is:
_________________________________________________________________________________________
Number and Street/Commercial Registered Office Provider
City
State
Zip
County
3. Complete part A or B if applicable:
A. The address to which the registered office of the association in this Commonwealth is to be changed to:
__________________________________________________________________________________________
Number and Street
City
State
Zip
County
B. The registered office of the association shall be provided by:
___________________________________________________________________________________________
Name of Commercial Registered Office Provider
County
4. The association has not made any filing in the Department from January 1, 2002 through December 31, 2011, in
accordance with 54 Pa.C.S. § 503(b).
5. The Association continues to exist.
IN TESTIMONY WHEREOF, the undersigned association has caused this Decennial Report of Association Continued Existence
to be signed by a duly authorized officer this _______ day of ______________, 20___.
_______________________________________________________
Name of Association
_______________________________________________________
Signature
Rev. 11/2010
_______________________________________________________
Title
American LegalNet, Inc.
www.FormsWorkFlow.com
Department of State
Bureau of Corporations and Charitable Organizations
P.O. Box 8722
Harrisburg, PA 17105-8722
(717) 787-1057
web site: www.dos.state.pa.us/corps
Instructions for Completion of Form:
A. Typewritten is preferred. If not, the form shall be completed in black or blue ink in order to permit reproduction.
The filing fee for this form is $70 with check or money order made payable to the Department of State.
B. The entity name as identified in the records of the Department of State Corporation Bureau has been entered in
Item 1. If the name has been changed, an Amendment form must be filed separately to effect this change on the
Department’s records.
C. The registered office as identified in the records of the Department of State Corporation Bureau has been
entered in Item 2. If the address has been changed, the current registered office or Commercial Registered
Office Provider and County of Venue should be identified in Item 3. 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.
D. In accordance with 54 Pa.C.S. § 503(b), no filing of this form is required if the association has made any filing
in the Department from January 1, 2002 through December 31, 2011, other than a decennial report, application
for registration of fictitious name, consent to appropriation of name, name searches or name reservations.
Additionally, no filing of this form is required if the association has had officer information forwarded to the
department by the Department of Revenue from January 1, 2002 through December 31, 2011, under 15
Pa.C.S. § 1110 (relating to annual report information).
E. This form and all accompanying documents shall be mailed to the address shown above.
American LegalNet, Inc.
www.FormsWorkFlow.com