Statement of Termination of a Business or Nonprofit Corporation (Pennsylvania)
This form is to terminate a business or nonprofit corporation in Pennsylvania. The form is desiring to terminate an amendment or plan that has not yet become effective, including Articles of Amendments, Merger, Consolidation, Division, Conversion, Exchange or Shares. The form provided here is simply a sample of what the actual Form 1902 or 5902 looks like.
PENNSYLVANIA DEPARTMENT OF STATE CORPORATION BUREAU
Statement of Termination
(15 Pa.C.S.)
____ Business Corporation (§ 1902)
____ Nonprofit Corporation (§ 5902)
Name _____________________________
Address ___________________________
City _______________________________
State ______________________
Zip Code __________________
Document will be returned to the name and address you enter
Check one of the following: Set forth in full in Exhibit A, attached hereto and made a part hereof, is a copy of the filing to be hereby terminated.
____ Articles of Amendment
____ Articles of Merger
____ Articles of Consolidation
____ Articles of Division
____ Articles of Conversion Statement with Respect to Shares (Business Only)
____ Articles of Exchange (Business Only)
2. Check as appropriate:
____ This statement has been executed by the corporation that filed the amendment.
____ This statement has been executed by each corporation that is a party to the plan to be terminated.
____ This statement has been executed by a corporation or corporations constituting less than all of the parties to the plan, as permitted by the plan to be terminated.
3. The amendment or plan has been terminated in accordance with the provisions thereof set forth therein.
IN TESTIMONY WHEREOF, the undersigned corporation(s) has (have) caused this Statement of Termination to be executed this __________________ day of ________________, _________.
________________________________________________ (Name of Corporation)
________________________________________________ (Signature)
________________________________________________ (Title)
________________________________________________ (Name of Corporation)
________________________________________________ (Signature)
________________________________________________ (Title)
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INSTRUCTIONS FOR FILLING OUT THIS FORM
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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 is $70 made payable to the Department of State.
B. The following, in addition to the filing fee, shall accompany this form: two copies of a completed form DSCB:15-134B (Docketing Statement-Changes) with respect to each association affected by the terminated filing.
C. This form and all accompanying documents shall be mailed to the above stated address.