Get the legal form you need right now

Statement of Summary of Record (Pennsylvania)

This form is a summary of record of a business or nonprofit corporation, or professional association in Pennsylvania. The form provided here is simply a sample of what the actual Form 1311/5311/9305 looks like.

PENNSYLVANIA DEPARTMENT OF STATE CORPORATION BUREAU

Statement of Summary of Record
(15 Pa.C.S.)

____ Business Corporation (§ 1311)
____ Nonprofit Corporation (§ 5311)
____ Professional Association (§ 9305)


Name _________________________________________

Address _________________________________________

City _________________________________________

State _________________________________________

Zip _________________________________________

Code _________________________________________

Document will be returned to the name and address you enter.

In compliance with the requirements of the applicable provisions of 15 Pa.C.S. (relating to corporations and unincorporated associations) the undersigned association hereby states that:

1. The name of the association is: __________________________

2. The (a) address of this association'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 ________________________________

(b) Name of Commercial Registered Office Provider c/o: _______________________________

County ________________________________

3. The statute by or under which it was incorporated or formed is: _________________________________

4. The association was originally incorporated or formed on _______________________ (Date)

under the following name: ______________________________________

5. Check and complete one of the following: The association was incorporated or formed by

____ Special act as set forth in Paragraph 3 above.

____ Decree of: _________________________ (Name of Court) entered on: ___________________ (Date).

____ Letters patent duly granted on: ___________________ (Date).

____ Filing of: _________________ (Articles of Incorporation, etc.)

in the: _______________________________ (Name of Department or other public office).

6. The original Articles were recorded on ________________ (Date)

in the following place ___________________________________

7. Check, and if appropriate complete, one of the following:

____ This certificate is being delivered to the Department of State contemporaneously with an amended and restated Articles of the association as set forth in Exhibit A attached hereto and made a part hereof.

____ The currently effective Articles of the association are filed or recorded as follows and the text of such currently effective Articles is set forth in Exhibit A attached hereto and made a part hereof (except any of such text which appears of record in the Department of State, which text is incorporated herein by reference to the records of the Department pursuant to 19 Pa. Code § 13.6 (relating to incorporation by reference)):

_________________________________________ (Recorder of Deeds book and page numbers, etc.)

____ Amended and restated Articles of the association which include all the information required to be set forth in the Articles of a Professional Corporation are set forth in Exhibit A attached hereto and made a part hereof.

8. Check, and if appropriate, complete one of the following:

____ The association has never adopted any name other than its original name and its current name.

____ Each name by which the association was known, other than its original name and its current name, and the date or dates on which each change of name of the association became effective, are as follows:

Name _________________________________________

Effective Date of Adoption _________________________________________


Name _________________________________________

Effective Date of Adoption _________________________________________


IN TESTIMONY WHEREOF, the undersigned association has caused this Statement of Summary of Record to be signed by a duly authorized officer thereof

this _________________ day of ___________________, ________.

Name of Association ________________________________

Signature __________________________________

Title ___________________________________


-----------------------------
INSTRUCTIONS FOR FILLING OUT THIS FORM
-----------------------------

Department of State
Corporation Bureau
P.O. Box 8722
Harrisburg, PA 17105-8722
(717) 787-1057
web site: www.dos.state.pa.us/corps

A. Typewritten is preferred. If not, the form shall be completed in black or blue-black ink in order to permit reproduction. The filing fee for this form, if applicable (see instruction C, below), is $70 made payable to the Department of State.

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. When this form accompanies another filing, e.g., articles of amendment, it will be deemed for filing fee and docketing statement purposes to be incorporated by reference into the filing to which it relates, and no separate filing fee shall be submitted. Otherwise, the following, in addition to the filing fee, shall accompany this form: one copy of a completed form DSCB:15-134A (Docketing Statement).

D. Set forth in Paragraph 6 the place or places, including volume and page numbers of their equivalent where the original Articles were filed or recorded. This information may be omitted if the first alternate of Paragraph 5 is applicable.

E. The first alternate of Paragraph 7 is applicable to a non-surviving party to a plan of merger which restates the Articles of the surviving corporation and to any corporation which is a party to a plan of consolidation.

F. Set forth in the second alternate of Paragraph 7 the place or places, including volume and page numbers or their equivalent, where the documents are filed or recorded, and the date or dates of each such filing or recording. Text which appears of record in the Department of State, may be incorporated by reference in this form to the records of the Department. This instruction is an exception to the general rule against incorporation by reference contemplated by 19 Pa. Code § 13.6 (relating to incorporation by reference).

G. The third alternate of Paragraph 7 is applicable only when this form is submitted with form DSCB:15-2905 (Statement of Election of Professional Corporation Status).

H. Include a clear and legible copy of the original Articles of Incorporation and all amendments, or restate the articles in their entirety.

I. A corporation is required to file this form only once.

J. This form and all accompanying documents shall be mailed to the address stated above.

Legal Forms Categories

Recently Added Forms

Library Of Legal Forms