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).
The provisions of this § 95.101 adopted April 17, 1992, effective April 18, 1992, 22 Pa.B. 1993.
APPENDIX A. [Reserved]
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
| 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 |
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.
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).
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).
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).
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).
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).
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).
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).
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).
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).
The provisions of this Form DSCB: UCC1 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
The provisons of this Form DSCB: UCC1Ad adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
The provisons of this Form DSCB: UCC1AP adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
The provisions of this Form DSCB: UCC3Ad adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
The provisions of this Form DSCB: UCC3 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
The provisions of this Form DSCB: UCC3AP adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
The provisions of this Form DSCB: UCC5 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
The provisions of this Form DSCB: UCC11 adopted February 18, 2011, effective February 19, 2011, 41 Pa.B. 985.
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