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. [Reserved]
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; amended May 10, 2013, effective May 11, 2013, 43 Pa.B. 2687; amended October 25, 2013, effective October 26, 2013, 43 Pa.B. 6469; reserved June 12, 2015, effective July 1, 2015, 45 Pa.B. 2973. Immediately preceding text appears at serial pages (374641), (374642), (368555), (368556), (356223), (284505), (284506), (356117) to (356122), (366607) to (366612), (284519) to (284524), (356125), (356127), (356128), (284529), (284530), (366613), (366614), (284533) to (284536), (368557) to (368560), (284541) to (284546), (371611), (371612), (284547) to (284550), (356129) to (356132), (284555) to (284598), (366615) to (366618), (284603), (284604), (356133), (356134), (284607) to (284610), (356135) to (356138), (368561) to (368564), (366623) to (366626), (356141), (356142), (284621) to (284638), (356143) to (356145), (284643) to (284646), (374643) to (374648), (284653), (284654), (366627), (366628), (284659) to (284664), (356147) to (356149), (374649) to (374652), (284673) to (284696), (356151) to (356154), (284701), (284702), (368565), (368566), (284707) to (284722), (368567) to (368571), (366629), (366630) and (356227) to (356240).
APPENDIX C. OFFICIAL FORMS
DSCB form number Form name Title 15 forms 15-108 Statement of Change of Registered Office by Agent Appx. 7 15-133/145/153 Copy/Certification Request Appx. 10 15-134A Docketing StatementNew Entity Appx. 12 15-134B Docketing StatementChanges Appx. 13 15-138 Statement of Correction Appx. 15 15-141 Statement of Abandonment Appx. 17 15-152(1) Preclearance of Document Appx. 19 15-153(a)(15) Expedited Service Request Appx. 20 15-153(a)(17) Special Processing Appx. 21 15-154 Statement of Unpaid Fee Appx. 22 15-161 Statement of DomesticationOther Appx. 23 15-208 Name Reservation/Transfer of Reservation Appx. 26 15-209 Application for Registration of Name of Nonregistered Foreign Association Appx. 29 15-335 Statement of Merger Appx. 32 15-335AD Statement of MergerAddendum Appx. 39 15-345 Statement of Interest Exchange Appx. 41 15-355 Statement of Conversion Appx. 46 15-366 Statement of Division Appx. 52 15-366AD Statement of DivisionAddendum Appx. 59 15-375 Statement of Domestication Appx. 61 15-412 Foreign Registration Statement Appx. 66 15-413 Amendment of Foreign Registration Appx. 71 15-415/417 Statement of Withdrawal of Foreign Registration Appx. 74 15-418 Transfer of Foreign Registration Appx. 78 15-1306/2102/ 2303/2702/2903/ 3101/3303/7102 Articles of IncorporationFor Profit Appx. 82 15-1311/5311/9305 Statement of Summary of Record Appx. 85 15-1341/5341 Statement of RevivalDomestic Corporation Appx. 89 15-1507/5507/ 8625/8825 Change of Registered Office Appx. 92 15-1522 Statement with Respect to SharesDomestic Business Corporation Appx. 94 15-1902/5902 Statement of TerminationDomestic Corporation Appx. 97 15-1915/5915 Articles of AmendmentDomestic Corporation Appx. 99 15-1971/5971 Voluntary Dissolution [Never Transacted Business] Domestic Corporation Appx. 102 15-1977/5977 Articles of DissolutionDomestic Corporation Appx. 105 15-1989/5989 Articles of Involuntary DissolutionDomestic Corporation Appx. 109 15-2104/2305 Articles of AmendmentDomestic Business CorporationElection of Nonstock/Statutory Close Status Appx. 112 15-2309A/2309B Breach/Cure of Qualifying Condition/Domestic Business/Statutory Close Corporation Appx. 115 15-2704/2904/3304 Articles of AmendmentDomestic Business CorporationElection of Management/Professional/Benefit Status Appx. 118 15-2905 Statement of Election of Professional Corporation Status Appx. 121 15-3331 Annual Benefit ReportBenefit Corporation Appx. 123 15-5110 Annual StatementNonprofit Corporation Appx. 126 15-5306/7102 Articles of IncorporationNonprofit Appx. 128 15-7104/7105/ 7106/7107 Articles of AmendmentElection/Termination of Cooperative Corporation Status Appx. 132 15-8201A Statement of RegistrationDomestic Limited Liability Partnership Appx. 135 15-8201B/8201C Statement of Amendment/TerminationDomestic Limited Liability Partnership Appx. 138 15-8205 [Reserved] Appx. 142 15-8221/8998 Certificate of Annual Registration Appx. 143 15-8433 Certificate of Partnership Authority Appx. 146 15-8434 Certificate of DenialGeneral Partnership Appx. 150 15-8474/8665 Certificate of Dissociation as Partner Appx. 152 15-8482(b)(2)(i) Certificate of DissolutionDomestic General Partnership Appx. 154 15-8482(b)(2)(vi) Certificate of TerminationDomestic General Partnership Appx. 156 15-8515 [Reserved] Appx. 158 15-8519 [Reserved] Appx. 159 15-8621 Certificate of Limited Partnership Appx. 160 15-8622/8822 Certificate of AmendmentDomesticLimited Partnership/Limited Liability Company Appx. 163 15-8636 Certificate of Negation Appx. 167 15-8681.1 Voluntary Termination [Never Transacted Business]Domestic Limited Partnership Appx. 169 15-8682(e) Certificate of TerminationLimited Partnership Appx. 171 15-8701A/8701B/ 8701C Statement of ElectionPartnershipElection/Amendment/Termination Appx. 173 15-8821 Certificate of OrganizationDomestic Limited Liability Company Appx. 176 15-8832 Certificate of Limited Liability Company Authority Appx. 180 15-8833 Certificate of DenialLimited Liability Company Appx. 184 15-8872(b)(2)(i) Certificate of DissolutionDomestic Limited Liability Company Appx. 186 15-8872(f) Certificate of TerminationDomestic Limited Liability Company Appx. 188 15-8878 Voluntary Termination [Never Transacted Business] Domestic Limited Liability Company Appx. 190 15-8898 Annual Benefit ReportBenefit Limited Liability Company Appx. 192 15-9120 Unincorporated Nonprofit AssociationAgent for Service of ProcessAppointment/Amendment/Cancellation Appx. 195 15-9120D Unincorporated Nonprofit AssociationResignation of Agent for Service of Process Appx. 198 19 Pa. Code forms 19-17.2 Consent to Appropriation of Name Appx. 200 Title 54 forms 54-311 Registration of Fictitious Name Appx. 202 54-312/313 Fictitious NameAmendment, Withdrawal, Cancellation Appx. 205 54-502 Registration or Renewal of Unincorporated Association Name Appx. 209 54-503 Decennial Report of Association Continued Existence Appx. 211 54-506 Statement of Termination of Registration of Association Name Appx. 213 54-1112 Registration of Trademark or Service Mark Appx. 215 54-1114/1115 Trademark/Service MarkRenewal or Assignment Appx. 219 54-1311/1312 InsigniaRegistration or Amendment Appx. 223 54-1314/1515 Decennial ReportInsignia or Mark Used with Articles or Supplies Appx. 226 54-1511/1512 Mark Used with Articles or SuppliesRegistration or Amendment Appx. 228 Title 13 forms UCC1 Uniform Commercial CodeFinancing Statement Appx. 231 UCC1Ad Uniform Commercial CodeFinancing Statement Addendum Appx. 233 UCC1AP Uniform Commercial CodeFinancing Statement Additional Party Appx. 235 UCC3 Uniform Commercial CodeFinancing Statement Amendment Appx. 237 UCC3Ad Uniform Commercial CodeFinancing Statement Amendment Addendum Appx. 239 UCC3AP Uniform Commercial CodeFinancing Statement Amendment Additional Party Appx. 241 UCC5 Information Statement Appx. 243 UCC11 Information Request Appx. 245
Source The provisions of this Appendix C adopted June 12, 2015, effective July 1, 2015, 45 Pa.B. 2973, unless otherwise noted.
Source The provisions of this form DSCB:15-134A amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial page (377154).
Source The provisions of this form DSCB:15-134B amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465. Immediately preceding text appears at serial pages (377155) to (377156).
Source The provisions of this form DSCB:15-153(a)(17) amended February 24, 2017, effective March 1, 2017, 47 Pa.B. 1250. Immediately preceding text appears at serial page (377163).
Source The provisions of this form DSCB:15-209 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377171) to (377173).
Source The provisions of this form DSCB:15-412 amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465; amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377694) to (377698).
Source The provisions of this form DSCB:15-413 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377213) to (377215).
Source The provisions of this form DSCB:15-418 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377220) to (377223).
Source The provisions of this form DSCB:15-1306/2102/2303/2702/2903/3101/3303/7102 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377224) to (377226).
Source The provisions of this form DSCB:15-1507/5507/8625/8825 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377234) to (377235).
Source The provisions of this form DSCB:15-1971/5971 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377244) to (377246).
Source The provisions of this form DSCB:15-3331 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377265) to (377268).
Source The provisions of this form DSCB:15-5306/7102 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377271) to (377274).
Source The provisions of this Form DSCB:15-8201A amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377278) to (377280).
Source The provisions of this form DSCB:15-8201B/8201C amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377281) to (377283).
Source The provisions of this form DSCB:15-8205 reserved January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377284) to (377285).
Source The provisions of this form DSCB:15-8221/8998 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567; amended March 22, 2019, effective March 23, 2019, 49 Pa.B. 1461. Immediately preceding text appears at serial pages (386281) to (386283).
Source The provisions of this DSCB:15-8433 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this DSCB:15-8434 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this form DSCB:15-8524/8532 renumbered as DSCB:15-8474/8665 and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377301) to (377302).
Source The provisions of this DSCB:15-8482(b)(2)(i) adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this DSCB:15-8482(b)(2)(vi) adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this form DSCB:15-8515 reserved January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377295) to (377297).
Source The provisions of this form DSCB:15-8519 reserved January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377298) to (377300).
Source The provisions of this Form DSCB:15-8511 renumbered as DSCB:15-8621 and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377288) to (377289).
Source The provisions of this form DSCB:15-8512/8951 renumbered as DSCB:15-8622/8822 and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377290) to (377292).
Source The provisions of this DSCB:15-8636 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this DSCB:15-8681.1 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this form DSCB:15-8513 renumbered as DSCB:15-8682(e) and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377293) to (377294).
Source The provisions of this form DSCB:15-8913 renumbered as DSCB:15-8821 and amended March 3, 2017, effective March 4, 2017, 47 Pa.B. 1444. Immediately preceding text appears at serial pages (377306) to (377308).
Source The provisions of this DSCB:15-8832 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this DSCB:15-8833 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this DSCB:15-8872(b)(2)(i) adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this form DSCB:15-8975 renumbered as DSCB:15-8872(f) and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377309) to (377310).
Source The provisions of this DSCB:15-8878 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this DSCB:15-8898 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.
Source The provisions of this form DSCB:54-311 amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465; amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377700) to (377702).
Source The provisions of this form DSCB:54-502 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377325) to (377326).
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