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Agent For Service Of Process DSCB 15-9120 - Pennsylvania

Agent For Service Of Process Form. This is a Pennsylvania form and can be used in Unincorporated Nonprofit Association Department Of State .
 Fillable pdf Last Modified 4/11/2014
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PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Agent for Service of Process (15 Pa.C.S. § 9120) __ Statement appointing agent __ Amendment of statement __ Cancellation of statement Unincorporated Nonprofit Association Name Address City State Zip Code Document will be returned to the name and address you enter to the left. Fee: $70 In compliance with the requirements of 15 Pa.C.S. § 9120 (relating to appointment of agent to receive service of process), the undersigned unincorporated nonprofit association and/or agent hereby states that: Complete boxes 1-3 for appointment, amendment and cancellation filings 1. The name of the unincorporated nonprofit association is: 2. The address, if any, in this Commonwealth of the above-named association is: Number and Street City State Zip County 3. The name and address in this Commonwealth of the person authorized to receive service of process for the above named association is: Name Number and Street City State Zip County American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-9120-2 For amendment of statement appointing agent only 4. The name and address in this Commonwealth of the person aut horized to receive service of process for the above named association is changed to: Name Number and Street City State Zip County For cancellation of statement appointing agent only 5. The status of the agent [named in box 3] authorized to receive service of process for the above-named association has been cancelled by the association. IN TESTIMONY WHEREOF, the undersigned have caused this Statement, Amendment or Cancellation of agent for service of process to be executed this day of , . ________________________________________ Name of Agent ________________________________________ Signature ________________________________________ Title ____________________________________________ Name of Unincorporated Nonprofit Association ____________________________________________ Signature ____________________________________________ Title 8/2013 American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-9120-3 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-black ink in order to permit reproduction. The filing fee for this form is $70.00 and should be made payable to the Commonwealth of Pennsylvania. Checks must contain a commercially pre-printed name and address. B. Agents resigning must use Resignation of Agent form (DSCB:15-9120D). 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. Appointment, amendment and cancellation of agent for service of process must be signed by both (i) a person authorized to manage the affairs of the nonprofit association; and (ii) the person appointed as the agent. D. This form and all accompanying documents shall be mailed to the address stated above. American LegalNet, Inc. www.FormsWorkFlow.com
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