FORMS


§ 95.101. Official forms.

 The following official forms have been promulgated under this chapter and appear in Appendix A:

   Form DSCB:UCC-1 (Uniform Commercial Code-Financing Statement).

   Form DSCB:UCC-3 (Uniform Commercial Code-Financing Statement Change).

   Form DSCB:UCC-11 (Uniform Commercial Code-Request for Information or Copies).

Source

   The provisions of this §  95.101 adopted April 17, 1992, effective April 18, 1992, 22 Pa.B. 1993.



APPENDIX A. [Reserved]



Source

   The provisions of this Appendix A reserved October 5, 2001, effective October 6, 2001, 31 Pa.B. 5621. Immediately preceding text appears at serial pages (278699) to (278956).

APPENDIX B


Form DSCB: 15-108 (Statement of Change of Registered
 Office by Agent) … Appx. 6
Form DSCB: 54-1112 (Application for Registration of Trademark or Service Mark) … Appx. 9
Form DSCB: 54-1114/1115 (Application for Renewal/Assignment of Registration of Mark) … Appx. 14
Form DSCB: 15-1306/2102/2303/2703/2903/3101/7102A (Articles of Incorporation-For Profit) … Appx. 18
Form DSCB: 54-1311/1312 (Insigina/Registration/Amendment
of Insigina) … Appx. 21
Form DSCB: 15-1311/5311/9305 (Certificate of Summary
of Record) … Appx. 24
Form DSCB: 54-1314/1515 (Decennial Report/Insigina/Mark
Used With Articles or Supplies) … Appx. 29
Form DSCB: 15-1341/5341 (Statement of Revival-Domestic) … Appx. 31
Form DSCB: 15-134A (Docketing Statement) … Appx. 34
Form DSCB: 15-134B (Docketing Statement (Changes)) … Appx. 35
Form DSCB: 15-138 (Statement of Correction) … Appx. 37
Form DSCB: 15-1507/4144/5507/6144/8506 (Statement of Change of Registered Office) … Appx. 40
Form DSCB: 54-1511/1512 (Registration/Amendment Mark
Used with Articles or Supplies) … Appx. 43
Form DSCB: 15-1522 (Statement with Respect to Shares Domestic
Business Corporation) … Appx. 46
Form DSCB: 15-162F (Statement of Consummation of
Domestication) … Appx. 49
Form DSCB: 15-162G/162H (Statement of Termination of
Domestication; Application for Renewal of Contingent or
Temporary Domestication Status) … Appx. 51
Form DSCB: 19-17.2 (Consent to Appropriation of Name) … Appx. 54
Form DSCB: 15-1902/5902 (Statement of Termination/Business/
Nonprofit Corporation) … Appx. 56
Form DSCB: 15-1915/5915 (Articles of Amendment-
Domestic Corporation) … Appx. 59
Form DSCB: 15-161/162E (Statement of Domestication; Statement of Contingent Domestication-Order) … Appx. 62
Form DSCB: 15-1926/5926/8547 (Articles/Certificate of Merger) … Appx. 66
Form DSCB: 15-162A/162B/162C/162D (Statement of Contingent Domestication-Foreign) … Appx. 71
Form DSCB: 15-1931 (Articles of Exchange; Domestic
Business Corporation) … Appx. 75
Form DSCB: 15-1954/5954/8579/8964 (Articles/Certificate
of Division) … Appx. 78
Form DSCB: 15-1963/5963 (Articles of Conversion) … Appx. 83
Form DSCB: 15-1971/5971 (Articles of Dissolution Before
Commencement of Business) … Appx. 86
Form DSCB: 15-1977/5977 (Articles of Dissolution-Domestic) … Appx. 89
Form DSCB: 15-1989/5989 (Articles of Involuntary
Dissolution-Domestic) … Appx. 93
Form DSCB: 15-2104/2305 (Articles of Amendment-Domestic
Business Corporation Election of Non-stock Status/Statutory
Close Status … Appx. 96
Form DSCB: 15-2309A/2309B (Domestic Business Corporation;
Statutory Close Corporation) … Appx. 99
Form DSCB: 15-2704/2904 (Articles of Amendment-Domestic
Business Corporation; Election of Management/Professional
Corporation Status … Appx. 102
Form DSCB: 15-2905 (Statement of Election of Professional
Corporation) … Appx. 105
Form DSCB: 19-3.104/154 (Statement of Unpaid Fee) … Appx. 108
Form DSCB: 54-311 (Application for Registration of
Fictitious Name) … Appx. 109
Form DSCB: 54-312/313 (Fictitious Name; Amendment, Withdrawal, Cancellation) … Appx. 113
Form DSCB: 15-4124/6124 (Application for
Certificate of Authority) … Appx. 117
Form DSCB: 15-4126/6126 (Application for Amended Certificate of
Authority Foreign Corporation) … Appx. 120
Form DSCB: 15-4127/6127 (Statement of Merger, Consolidation or
Division; Qualified Foreign Corporation) … Appx. 123
Form DSCB: 15-4128/6128 (Certificate of Revocation-
Foreign Corporation) … Appx. 126
Form DSCB: 15-4129/6129 (Application for Termination of
Authority Foreign Corporation) … Appx. 127
Form DSCB: 15-4130/6130 (Statement of Change of Address by
Withdrawn Corporation Foreign Corporation) … Appx. 130
Form DSCB: 15-4131/6131 (Application for Registration of Name; Nonqualified Foreign Corporation) … Appx. 133
Form DSCB: 15-4161/6161 (Articles of Domestication-Foreign) … Appx. 135
Form DSCB: 54-502 (Application for Registration of Unincorporated Association Name) … Appx. 139
Form DSCB: 54-503 (Decennial Report of Association
Continued Existence) … Appx. 141
Form DSCB: 54-506 (Statement of Termination of Registration of
Association Name) … Appx. 143
Form DSCB: 15-5110 (Annual Statement-Nonprofit Corporation) … Appx. 147
Form DSCB: 15-5306/7102B (Articles of Incorporation-Nonprofit) … Appx. 149
Form DSCB: 15-7104/7105/7106/7107 (Articles of Amendment;
Election/Termination of Cooperative Corporation Status … Appx. 154
Form DSCB: 15-8103A/8103B (Procedure for Continuation of
Business Domestic Limited Partnership and Domestic Limited
Liability Company) … Appx. 157
Form DSCB: 15-8201A (Statement of Registration Domestic
Registered Limited Liability Partnership) … Appx. 160
Form DSCB: 15-8201B/8201C (Amendment/Termination Domestic
Registered Limited Liability Partnership) … Appx. 163
Form DSCB: 15-8205 (Statement of Withdrawal from Registered
Limited Liability Partnership) … Appx. 166
Form DSCB: 15-8221/8998 (Certificate of Annual Registration) … Appx. 168
Form DSCB: 15-8511 (Certificate of Limited Partnership) … Appx. 171
Form DSCB: 15-8512/8951 (Certificate of Amendment-Limited
Partnership/Limited Liability Company) … Appx. 174
Form DSCB: 15-8513 (Certificate of Cancellation Limited
Partnership) … Appx. 177
Form DSCB: 15-8515 (Certificate Pursuant to Judicial Order Limited Partnership) … Appx. 180
Form DSCB: 15-8519 (Certificate of Summary of Record Limited
Partnership) … Appx. 183
Form DSCB: 15-8524/8532 (Certificate of Withdrawal) … Appx. 186
Form DSCB: 15-8546/8957 (Certificate of Termination-Limited
Partnership-Limited Liability Company) … Appx. 188
Form DSCB: 15-8585 (Certificate of Amendment of
Registration-Foreign) … Appx. 191
Form DSCB: 15-8586 (Certificate of Cancellation of
Registration-Foreign) … Appx. 194
Form DSCB: 15-8590/8982 (Certificate of Dissolution/Dissolution by Domestication-Certificate of Domestication-Foreign) … Appx. 197
Form DSCB: 15-8981/8211/8582 (Application for
Registration-Foreign) … Appx. 200
Form DSCB: 15-8701A/8701B/8701C (Electing Partnership) … Appx. 203
Form DSCB: 15-8906 (Certificate of Change of Registered Office
Limited Liability Company) … Appx. 206
Form DSCB: 15-8908 (Certificate of Election by Professional
Association of Limited Liability Company Status) … Appx. 209
Form DSCB: 15-8958 (Certificate of Merger or Consolidation
Limited Liability Company) … Appx. 212
Form DSCB: 15-8975/8978 (Domestic Limited Liability Company) … Appx. 217
Form DSCB: 15-8913 (Certificate of Organization Domestic Limited
Liability Company) … Appx. 220
Form DSCB: 15-8962 (Certificate of Termination-Limited
Liability Company) … Appx. 223
Form DSCB: UCC1 (Uniform Commercial Code-Financing
Statement) … Appx. 225
Form DSCB: UCC1 Ad (Uniform Commercial Code-Financing
Statement Addendum) …Appx.227
Form DSCB: UCC1 AP (Uniform Commercial Code-Financing
Statement Additional Party) …Appx. 229
Form DSCB: UCC3 Ad (National Uniform Commercial Code-Financing
Statement Amendment Addendum) … Appx. 231
Form DSCB: UCC3 (Uniform Commercial Code-Financing
Statement Amendment) … Appx. 233
Form DSCB: UCC3AP (Uniform Commercial Code-Financing
Statement Amendment Additional Party) … Appx. 235
Form DSCB: UCC5 (Statement Of Claim) … Appx. 237
Form DSCB: UCC11 (National Information Request) … Appx. 239



Source

   The provisions of this Appendix B adopted October 5, 2001, effective October 6, 2001, 31 Pa.B. 5621; amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

108-1

108-2

108-3

1112-1

1112-2

1112-3

1112-4

1112-5

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial pages (284507) to (284511).

1114-1

1114-2

1114-3

1114-4

1306-1

1306-2

1306-3

1311-1

1311-2

1311-3

5311-1

5311-2

5311-3

5311-4

1314-2

1314-3

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial pages (284526) to (284528).

1341-1

1341-2

1341-3

15134a-1

15134b-1

15134b-1

138-1

138-2

138-3

1507-1

1507-2

1507-3

1511-1

1511-2

1511-3

1522-1

1522-2

1522-3

161-1

161-2

161-3

161-4

162f-1

162f-2

162g-1

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial pages (284552) to (284553).

162g-2

162g-2

17.2-1

17.2-2

1902-1

1902-2

1902-3

1915-1

1915-2

1915-3

1926-1

1926-2

1926-3

1926-4

1926-5

162a-1

162a-2

162a-3

162a-4

1931-1

1931-2

1931-3

1954-1

1954-2

1954-3

1954-4

1954-5

1963-1

1963-2

1963-3

1971-1

1971-2

1971-3

1977-1

1977-2

1977-3

1977-4

1989-1

1989-2

1989-3

2104-1

2104-2

2104-3

2309a-1

2309a-2

2309a-3

2704-1

2704-2

2704-3

2905-1

2905-2

2905-3

3.140-1

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial page (284606).

311-1

311-2

311-3

311-4

312-1

312-2

312-3

312-4

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial pages (284611) to (294614).

4124-1

4124-2

4124-3

4126-1

4126-2

4126-3

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text text appears at serial pages (284618) to (284620).

4127-1

4127-2

4127-3

4128-1

4128-2

4128-3

4128-4

4130-1

4130-2

4130-3

4131-1

4131-2

4161-1

4161-2

4161-3

4161-4

502-1

502-2

503-1

1752-30-02

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial pages (284639) to (284641).

506-1

506-2

506-3

5110-1

5110-2

5306-1

5306-2

5306-3

5306-4

5306-5

7104-1

7104-2

7104-3

8103-1

8103-2

8103-3

8201a-1

8201a-2

8201a-3

8201b-1

8201b-2

8201b-3

8205-1

8205-2

1752-30-14

1752-30-15

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial pages (284666) to (284668).

8511-1

8511-2

8511-3

8512-1

8512-2

8512-3

8513-1

8513-2

8513-3

8515-1

8515-2

8515-3

8519-1

8519-2

8519-3

8524-1

8524-2

8546-1

8546-2

8546-3

8585-1

8585-2

8585-3

8586-1

8586-2

8586-3

8590-1

8590-2

8590-3

1752-30-16

1752-30-17

1752-30-18

Source

   The provisions of this form amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985. Immediately preceding text appears at serial pages (284698) to (284700).

8701a-1

8701a-2

8701a-3

8906-1

8906-2

8906-3

8908-1

8908-2

8908-3

8913-1

8913-2

8913-3

8958-1

8958-2

8958-3

8958-4

8958-5

8913-1

8962-2

8975-1

8975-2

8975-3

1752-30-19

1752-30-20

Source

   The provisions of this Form DSCB: UCC1 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

1752-30-21

1752-30-22

Source

   The provisons of this Form DSCB: UCC1Ad adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

1752-30-23

1752-30-24

Source

   The provisons of this Form DSCB: UCC1AP adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

1752-30-25

1752-30-26

Source

   The provisions of this Form DSCB: UCC3Ad adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

1752-30-27

1752-30-28

Source

   The provisions of this Form DSCB: UCC3 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

1752-30-29

1752-30-30

Source

   The provisions of this Form DSCB: UCC3AP adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

1752-30-31

1752-30-32

Source

   The provisions of this Form DSCB: UCC5 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.

1752-30-33

1752-30-34

Source

   The provisions of this Form DSCB: UCC11 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.



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