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PENNSYLVANIA DEPARTMENT OF STATE 
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS       
      Return document by mail to:                                                                             
                                                                                                  Amendment of Foreign Registration 
                                                                                               
                                                                                                             DSCB:15-413 
 Name                                                                                               
                                                                                                                                                                                                                         (7/1/2015) 
 Address                                                                                                      
  
 City                                              State                             Zip Code 
                                                                                                     *413*  
      Return document by email to: _________________________________                                         413 
 
      Read all instructions prior to completing. This form may be submitted online at https://www.corporations.pa.gov/.  
 
Fee:  $250 
 
               In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 413 (relating to amendment of 
foreign registration statement), the undersigned registered foreign association hereby states that: 
 
1. The name of the association under which it is registered to do business in this Commonwealth is: 
 
 2. The type of association is (check only one): 
              Business Corporation                                   Limited Partnership                      Business Trust 
              Nonprofit Corporation                                  Limited Liability (General) Partnership  Professional Association 
              Limited Liability Company                              Limited Liability Limited Partnership     
 
3.  The (a) address of the association’s registered office in this Commonwealth or (b) name of its Commercial Registered 
Office Provider and the county of venue is: 
 
Complete part (a) OR (b) – not both: 
 
(a)  ________________________________________________________________________________________________________        
           Number and street                                           City                                             State                        Zip                  County 
                                                                                              OR 
                                                                                               
(b) c/o: _____________________________________________________________________________________________________ 
              Name of Commercial Registered Office Provider                                                                                              County 
 
4.  Effective date of amendment of foreign registration (check, and if appropriate complete, one of the following): 
      The Amendment of Foreign Registration shall be effective upon filing in the Department of State. 
      The Amendment of Foreign Registration shall be effective on: ________________________ at _______________. 
                                                                                                    Date (MM/DD/YYYY)                          Hour (if any) 
 



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  DSCB:15-413 - 2 
   
  5.  Check, and if appropriate complete, one of the following: 
      The association desires that its registration be amended to change or correct the following information: 
       
        _______________________________________________________________________________________________________ 
     
        _______________________________________________________________________________________________________ 
     
        _______________________________________________________________________________________________________ 
       
      The amendment adopted by the association is set forth in full in Exhibit A attached hereto and made a part hereof. 
    
  If the amendment reflects a change in name for the association which does not comply with 15 Pa.C.S. § 414  and §§ 201-209, the 
  foreign association must adopt an alternate name that complies with 15 Pa.C.S. §§ 201-209 for use in Pennsylvania and a resolution 
  from the association’s governors adopting the name must be attached. 
   
  IN TESTIMONY WHEREOF, the undersigned association has caused this Amendment of Foreign Registration Statement 
  to be signed by a duly authorized representative thereof this ______________ day of     ____________________________ 
  20__________. 
   
                                                                       ______________________________________ 
                                                                                         Name of Association 
   
                                                                       ___________________________________________________ 
                                                                                        S ig n a tu r e  
   
                                                                       ___________________________________________________ 
                                                                                           Title 
   



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DSCB:15-413–Instructions 
 
                                               Pennsylvania Department of State 
                                  Bureau of Corporations and Charitable Organizations 
                                                            P.O. Box 8722 
                                                  Harrisburg, PA  17105-8722 
                                                            (717) 787-1057 
                                               web site: www.dos.pa.gov/corps 
General Information                                              document or correspondence may be downloaded. Any email 
Typewritten is preferred.  If handwritten, the form must be      or mailing addresses provided on this form will become part 
legible and completed in black or blue-black ink in order to     of the filed document and therefore public record. 
                                                                  
permit reproduction.                                             1.  Give the exact name of the association as registered to do 
 
The nonrefundable filing fee for this form is $250. Checks       business in Pennsylvania and as on file with the Department of 
should be made payable to the Department of State.  Checks       State.If  a foreign association has adopted an alternate name in 
must contain a commercially pre-printed name and address.        order to register to do business in Pennsylvania, the registered 
                                                                 foreign association must use the alternate name in response to 
This form and all accompanying documents shall be mailed to      a requirement that a document delivered to the Department for 
the address stated above.                                        filing state the name of the association. This field is required. 
                                                                  
Who should file this form?                                       2. Select the type of association.  Only one option may be 
A foreign association that is registered to do business in this  selected. This field is required. 
Commonwealth must deliver to the Department for filing an         
amendment to its foreign registration statement if there is a    3. Give one of the following:  the current registered office 
change in any of the following:                                  address in the Commonwealth in (a) or the name of a 
 (1) The name of the association.                                Commercial Registered Office Provider (b) and the county of 
 (2) The type of association, including, if it is a foreign      venue, as on file with the Department of State at the time the 
limited partnership, whether the association became or ceased    amendment is submitted for filing.   
                                                                  
to be a foreign limited liability limited partnership.           Post office boxes are not acceptable for any address. Under 15 
 (3) The association’s jurisdiction of formation.                Pa.C.S. § 135(c) (relating to addresses), an actual street or 
 (4) An address required by section 412(a)(4) (relating to       rural route box number must be used as an address, and the 
foreign registration statement).                                 Department of State is required to refuse to receive or file any 
 (5) Its registered office.                                      document that sets forth only a post office box address.   
 (6) The authority of the association to have one or more        This field is required.  
series.                                                           
 
Applicable Law                                                   4. Any date specified as the effective date of the Amendment 
For foreign associations, in general, 15 Pa.C.S. §§ 102; 401-    of Foreign Registration must be a future effective date (after 
419; for amendment, 15 Pa.C.S. § 413; for names, 15 Pa.C.S.      the date and time of its delivery to the Department). A 
§ 414 and §§ 201-209. Statutes are available on the              specified effective date may not be retroactive (prior to the 
Pennsylvania General Assembly website,                           date and time of the delivery of the Amendment of Foreign 
www.legis.state.pa.us, by following the link for Statutes.       Registration to the Department).  If a delayed effective date is 
                                                                 specified, but no time is given, then the time used will be 
Attachments                                                      12:01 a.m. on the date specified. If neither option for an 
The following, in addition to the filing fee, shall accompany    effective date is checked, it will be presumed that no specified 
this form:                                                       delayed effective date is intended and the document will be 
 (1)One   copy of a completed form DSCB: 15-134B                 effective upon filing. This field is required. 
(Docketing Statement - Changes).                                  
 (2)Any    necessary copies of form DSCB: 19-17.2 (Consent       5. Supply the change(s) to the information previously supplied 
to Appropriation of Name). If Consent cannot be obtained, the    in the association’s Foreign Registration Statement 
association may adopt, for the purpose of doing business in      (DSCB:15-412). If the amendment reflects a change in name 
this Commonwealth, an alternate name that complies with 15       for the association which does not comply with 15 Pa.C.S. § 
Pa.C.S. § 414 and §§ 201-209.                                    414 and 15 Pa.C.S. §§ 201-209, the foreign association must 
 (3)Any    necessary governmental approvals.                     have consent to use the name or adopt an alternate name that 
 (4)If the association must adopt an alternate name for use in   complies 15 Pa.C.S. §§ 201-209 for use in Pennsylvania and 
Pennsylvania, a resolution adopting the name must be             the consent or a resolution from the association’s governors 
attached.                                                        adopting the name must be attached. This field is required. 
                                                                  
                                                                 Signature and Verification 
Form Instructions                                                An authorized representative of the foreign association must 
Enter the name and mailing address to which any                  sign the Amendment of Foreign Association. Signing a 
correspondence regarding this filing should be sent.  This field document delivered to the Department for filing is an 
must be completed for the Bureau to return the filing. If the    affirmation under the penalties provided in 18 Pa.C.S. § 4904 
filing is to be returned by email, an email address must be      (relating to unsworn falsification to authorities) that the facts 
provided. An email will be sent to address provided,             stated in the document are true in all material respects.  
containing a link and instructions on how a copy of the filed    This field is required. 






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