Articles Of Amendment Election Termination Of Cooperative Corporation Status {DSCB 15-7104-7107}

PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Name Address City State Zip Code Articles of Amendment - Election/Termination of Cooperative Corporation Status DSCB:15-7104/7105/7106/7107 (rev. 7/2015) *71046* 71046 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 Check one: Domestic Business Corporation - Election (§ 7104) Domestic Nonprofit Corporation - Election (§ 7106) Domestic Cooperative Corporation For Profit - Termination (§ 7105) Domestic Nonprofit Cooperative Corporation - Termination (§ 7107) In compliance with the requirements of the applicable provisions (relating to election of an existing business/nonprofit corporation to become a cooperative corporation)/(relating to termination of status as a cooperative corporation for profit or termination of nonprofit cooperative corporation status), the undersigned business/nonprofit corporation or business/nonprofit cooperative corporation, hereby states that: 1. The name of the corporation is: 2. The (a) address of this corporation's current registered office in this Commonwealth or (b) name of its commercial registered office provider and the county of venue is (the Department is hereby authorized to correct the following information to conform to the records of the Department): (a) Number and Street City State Zip County c/o: (b) Name of Commercial Registered Office Provider County 3. The statute by or under which it was incorporated: 4. The date of its incorporation: _____________________________ MM/DD/YYYY 5. Check, and if appropriate complete, one of the following: The amendment shall be effective upon filing these Articles of Amendment in the Department of State. The amendment shall be effective on: Date (MM/DD/YYYY) at Hour (if any) . American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-7104/7105/7106/7107­2 6. Check one of the following: The amendment was adopted by the shareholders or members pursuant to 15 Pa.C.S. §§ 1905, 1914 and § 7104(b)/7105(b) or §§ 5905, 5914 and § 7106(b)/7107(b). The amendment was adopted by the board of directors and shareholders (or members) or members (or shareholders) pursuant to 15 Pa.C.S. §§ 1914 and 7104(b)/7105(b) or §§ 5914 and 7106(b)/7107(b). Election of Cooperative Corporation Status Only: complete paragraphs 7, 8 and 9 7. The corporation elects to become a cooperative corporation. 8. Complete and strike out the inapplicable term: The common bond of membership among its (members) (shareholders) is: . 9. For Domestic Business Corporation Only: Strike out if inapplicable: The corporation is organized on a non-stock basis. 10. Check, and if appropriate, complete one of the following: The amendment adopted by the corporation, set forth in full, is as follows: The amendment adopted by the corporation is set forth in full in Exhibit A attached hereto and made a part hereof. 11. Check if the amendment restates the Articles: The restated Articles of Incorporation supersede the original Articles and all amendments thereto. IN TESTIMONY WHEREOF, the undersigned corporation has caused these Articles of Amendment to be signed by a duly authorized officer thereof this day of , . Name of Corporation Signature Title American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-7104/7105/7106/7107­Instructions 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 Instructions for Completion of Form: A. Typewritten is preferred. If handwritten, the form shall be legible and completed in black or blue-black ink in order to permit reproduction. The nonrefundable filing fee for this form is $70 made payable to the Department of State. Checks must contain a commercially pre-printed name and address. 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, an email address must be provided. An email will be sent to address provided, containing a link and instructions on how a copy of the filed document or correspondence may be downloaded. Any email or mailing addresses provided on this form will become part of the filed document and therefore public record. 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. The following, in addition to the filing fee, shall accompany this form: (1) Two copies 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). (3) Any necessary governmental approvals. D. This form and all accompanying documents shall be mailed to the above stated address. Instructions for Election of Cooperative Corporation Status F. For general instructions relating to the incorporation of cooperative corporations see 19 Pa. Code Ch. 51 (relating to cooperative corporations). Under 15 Pa.C.S. § 7103 (relating to use of term "cooperative" in corporate name), the corporate name in Paragraph 10 must, unless otherwise provided by statute, contain one of the terms "cooperative" or "coop." See 19 Pa. Code § 17.7 (relating to cooperative names). Instructions for Termination of Cooperative Corporation Status G. For Domestic Cooperative Corporation for Profit Only: The amendment set forth in Paragraph 10 shall eliminate any provisions permitted or required by 15 Pa.C.S. §§ 2102(a)(1) and 2103 if the corporation is organized as a non-stock corporation and is not to continue as such, shall eliminate the common bond of membership provisions required by 15 Pa.C.S. § 7102(a) and shall change the name of the corporation to comply with 15 Pa.C.S. § 7103 and other applicable provisions of law. See 19 Pa. Code § 17.7 (relating to cooperative names). H. For Domestic Nonprofit Cooperative Corporation Only: The amendment set forth in Paragraph 10 shall eliminate the common bond of membership provisions required by 15 Pa.C.S. § 7102(a) and shall change the name of the corporation to comply with 15 Pa.C.S. § 7103 and other applicable provisions of law. See