Transfer Of Foreign Registration {DSCB 15-418}

PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Name Address City State Zip Code Return document by email to: _________________________________ Read all instructions prior to completing. This form may be submitted online at https://www.corporations.pa.gov/. Fee: $70 In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 418 (relating to transfer of registration), the undersigned registered foreign association hereby states that: 1. The name of the association under which it is registered to do business in this Commonwealth and before the merger or conversion is: 2. The type of association before the merger or conversion is (check only one): Business Corporation Limited Partnership Nonprofit Corporation Limited Liability (General) Partnership Limited Liability Company Limited Liability Limited Partnership Business Trust Professional Association 3. The name of the association following the merger or conversion: 3A. If the name in 3 does not contain a required designator or if the name in 3 is not available for use in the Commonwealth, the alternate name under which the association is registering in this Commonwealth is: 4. The type of association after the merger or conversion (check only one): Business Corporation Limited Partnership Nonprofit Corporation Limited Liability (General) Partnership Limited Liability Company Limited Liability Limited Partnership Business Trust Professional Association 5. The jurisdiction of formation of the association after the merger or conversion is: ______________________________ American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-418 - 2 If different than the information for the registered foreign association before the merger or conversion, all of the following information for the association after the merger or conversion: 6A. The street and mailing address of the association's principal office is: ____________________________________________________________________________________________________________ Number and street City State Zip 6B. The street and mailing address of the office, if any, required to be maintained by the law of the association's jurisdiction of formation in that jurisdiction is: ____________________________________________________________________________________________________________ Number and street City State Zip 7. The (a) address of the association's registered office in this Commonwealth or (b) name of its Commercial Registered Office Provider and the county of venue is: Complete part (a) OR (b) ­ not both: (a) ________________________________________________________________________________________________________ Number and street City State Zip County OR (b) c/o: _____________________________________________________________________________________________________ Name of Commercial Registered Office Provider County 8. Effective date of transfer of foreign registration is (check, and if appropriate complete, one of the following): The Transfer of Foreign Registration shall be effective upon filing in the Department of State. The Transfer of Foreign Registration shall be effective on: _________________________ at __________________. Date (MM/DD/YYYY) Hour (if any) IN TESTIMONY WHEREOF, the undersigned registered foreign association has caused this Transfer of Foreign Registration to be signed by a duly authorized representative of the surviving or converted association this __________ day of _________________________20_____ __. ______________________________________ Name of Association ___________________________________________________ Signature ___________________________________________________ Title American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-418­Instructions 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 handwritten, the form must be legible and completed in black or blue-black ink in order to permit reproduction. The nonrefundable filing fee for this form is $70. Checks should be made payable to the Department of State. Checks must contain a commercially pre-printed name and address. This form and all accompanying documents shall be mailed to the address stated above. Who should file this form? If a registered foreign association merges into a nonregistered foreign association or converts to a foreign association required to register with the Department of State to do business in this Commonwealth, the association shall deliver to the Department for filing an application for Transfer of Registration. When an application for Transfer of Registration takes effect, the registration of the registered foreign association to do business in this Commonwealth is transferred without interruption to the association into which it has merged or to which it has been converted. The purpose of this filing is to clarify the status of the registered foreign association in the public records of the Department of State. A Transfer of Registration has the twofold effect of canceling the authority of the foreign association to do business in Pennsylvania while at the same time reregistering it as the new type of foreign association. If the reregistered foreign association subsequently wishes to terminate its registration to do business, it may do so under 15 Pa.C.S. § 419. Applicable Law For foreign associations, in general, 15 Pa.C.S. §§ 102; 401419; for transfer of registration, 15 Pa.C.S. § 418; for names, 15 Pa.C.S. § 414 and §§ 201-209. Statutes are available on the Pennsylvania General Assembly website, www.legis.state.pa.us, by following the link for Statutes. Attachments The following, in addition to the filing fee, shall accompany this form: (1) One copy of a completed form DSCB: 15-134B (Docketing Statement - Changes). (2) Any necessary copies of form DSCB: 19-17.2 (Consent to Appropriation of Name). If Consent cannot be obtained, the association may adopt, for the purpose of doing business in this Commonwealth, an alternate name that complies with 15 Pa.C.S. § 414 and §§ 201209. (3) Any necessary governmental approvals. Form Instructions Enter the name and mailing address to which any correspondence regarding this filing should be sent. This field must be completed for the Bureau to return the filing. If the filing is to be returned by email, a