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Docketing Statement (New Entity) DSCB 15-134A - Pennsylvania

Docketing Statement (New Entity) Form. This is a Pennsylvania form and can be used in Docketing Statements Department Of State .
 Fillable pdf Last Modified 12/29/2012
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Docketing Statement DSCB:15-134A (Rev 2012) Departments of State and Revenue One (1) required BUREAU USE ONLY: Dept. of State Entity # _______________________ Dept. of Rev. Box # _________________________ Filing Period ____________Date 3 4 5 __________ SIC/NAICS _____________Report Code ________ Check proper box: Pennsylvania Entities business stock business non-stock professional nonprofit stock nonprofit non-stock statutory close management cooperative insurance ____benefit limited liability company restricted professional limited liability company business trust Foreign Entities State/Country Date______ business ____benefit nonprofit limited liability company restricted professional limited liability company business trust Other domestication division consolidation 1. Entity Name: 2. Individual name and mailing address responsible for initial tax reports: Name Number and street City State Zip 3. Description of business activity: 4. Specified effective date, if any: month/day/year hour, if any 5. EIN (Employer Identification Number), if any: 6. Fiscal Year End: 7. Fictitious Name (only if foreign corporation is transacting business in PA under a fictitious name): American LegalNet, Inc. www.FormsWorkFlow.com
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