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Statement Of Termination Of Registration Of Association Name - Pennsylvania
|Statement Of Termination Of Registration Of Association Name Form. This is a Pennsylvania form and can be used in Fictitious Names Department Of State .||
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PENNSYLVANIA DEPARTMENT OF STATE CORPORATION BUREAU Statement of Termination Entity Number of Registration of Association Name (5 4 Pa.C.S. 506 ) Name Doc ument will be returned to the name and address you enter to the left . Address City State Zip Code Fee: $70 Filed in the Department of State on __________________________ Secretary of the Commonwealth In compliance with the requirements of 5.C4. PaS. 506 (relating to voluntary termination of registration by coatrpioorns and other associations), the undersigned association, desiring to terminate the registration of its name with the Departmte, hent ofer Steby astates that: 1. The name of the association is: 2. The (a) address of this associations present registerefice ind of this Commonwealth or (b) name of its commercial registered office prover idand the county of venue is: (a) Number and Street City State Zip County (b) Name of Commercial Registered Office Provider County c/o: 3. The name of the association was registered on under the following statute: Date . 4. The registration of the name of the association under 54 Pa.C.S. Ch.5 (relating to corporation and other association names) is hereby terminated. <<<<<<<<<********>>>>>>>>>>>>> 2DSCB:54-506-2 IN TESTIMONY WHEREOF, th e undersigned association has caused this Statement of Termination of Registration of Name to be signed by a duly authorized officer this day of , . Name of Association Signature Title <<<<<<<<<********>>>>>>>>>>>>> 3 Department of State Corporation Bureau 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 made payable to the Department of State. 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 fuse to recere ive or file any document that sets forth only a post office box address. C. The applicable statute to be inserted in Paragraph 3 should be determined byference to the basis of registration set re forth in 54 Pa.C.S. 501(a) (relating to register established). D. This form and all accompanying documents shall be mailed to the address stated above. E. To receive confirmation of the file date prior to receiving the microfilmed original, send either a self-addressed, stamped postcard with the filing information noted a self-addressed, stamped envelope wor ith a copy of the filing document.