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 PENNSYLVANIA DEPARTMENT OF STATE 
 BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS       
        Return document by mail to:                                                                                         
                                                                                                         Statement of Correction 
    
                                                                                                                       DSCB:15-138 
   Name 
                                                                                                                                                                                                               (rev. 7/1/2015)  
   Address                                                                                                                  
    
   City                                                State                             Zip Code        *138*  
    
                                                                                                                        138 
        Return document by email to: _________________________________
  
        Read all instructions prior to completing. This form may be submitted online at https://www.corporations.pa.gov/.  
  
 Fee:  $70 
  
            In compliance with the requirements of 15 Pa.C.S. § 138 (relating to statement of correction), the undersigned 
 association or other person, desiring to correct an inaccurate, defective or erroneous record, hereby states that: 
  
 1.  The name of the association or other person is:  _________________________________________________________ 
  
 2.  The current registered office address as on file with the Department of State. Complete part (a) OR (b) – not both: 
     
    (a)  _____________________________________________________________________________________________________       
               Number and street                                             City                                        State                   Zip                  County 
      
    (b) c/o: __________________________________________________________________________________________________ 
                  Name of Commercial Registered Office Provider                                                                                            County 
  
 3. The statute by or under which the association was formed (or the preceding filing was made, in the case of a filing that 
    does not constitute a part of the public organic record of an association) is: ___________________________________ 
  
 4. The inaccuracy or defect to be corrected is (include Department of State form name and date filed): 
     
  5.  Check one of the following: 
        The       portion of the document requiring correction in corrected form is set forth in Exhibit A attached hereto. 
        The       original document to which this statement relates shall be deemed re-executed. 
        The original document to which this statement relates shall be deemed stricken from the records of the Department. 
   
  IN TESTIMONY WHEREOF, the undersigned association or other person has caused this Statement of Correction to be 
  signed by a duly authorized officer thereof or otherwise in its name this ______________ day of  
 ____________________________, 20_______. 
  
                                                                                                    ______________________________________ 
                                                                                                                       Name of Association 
  
                                                                                                   ___________________________________________________ 
                                                                                                                   S ig n a tu r e  
  
                                                                                                   ___________________________________________________ 
                                                                                                                     Title 



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DSCB:15-138 - 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                                               filing is to be returned by email, an email address must be 
Typewritten is preferred.  If handwritten, the form must be       provided. An email will be sent to address provided, 
legible and completed in black or blue-black ink in order to      containing a link and instructions on how a copy of the filed 
permit reproduction.                                              document or correspondence may be downloaded. Any email 
                                                                  or mailing addresses provided on this form will become part 
The nonrefundable filing fee for this form is $70. Checks         of the filed document and therefore public record. 
should be made payable to the Department of State.  Checks         
must contain a commercially pre-printed name and address.         1.  Give the exact name of the association. The name on this 
                                                                  line must match exactly the association name as provided in 
This form and all accompanying documents shall be mailed to       the document sought to be corrected and in the Department’s 
the address stated above.                                         records at the time this Statement of Correction is submitted 
                                                                  for filing. This field is required. 
Applicable Law                                                     
See 15 Pa.C.S. § 138 for general information on Statement of      2. Current address. The address provided must be the 
Correction. Statutes are available on the Pennsylvania General    association’s registered office address (a) or Commercial 
Assembly website,  www.legis.state.pa.us, by following the        Registered Office Provider (b) as on file with the Department 
link for Statutes.                                                of State at the time this Statement of Correction is submitted 
                                                                  for filing. This field is required. 
Who should file this form?                                         
Whenever any document authorized or required to be                3.  Supply the statute by or under which the association was 
delivered to the Department of State for filing has been so       formed, or the preceding filing was made, in the case of a 
filed and is an inaccurate record of the action therein referred  filing that does not constitute a part of the public organic 
to or was defectively or erroneously executed, the document       record of an association. Example: Business Corporation Law 
may be corrected by delivering to the Department for filing a     of 1988, Limited Liability Company Law of 1994.  
Statement of Correction.                                          This field is required. 
                                                                   
Only documents that have already taken effect may be              2.  The type of document to be abandoned is the name of the 
corrected under this section.  If a document has not yet taken    form or document previously submitted, which has not yet 
effect, it may be abandoned under 15 Pa.C.S. § 141 if the         become effective: Statement of Merger, Articles of 
requirements of that section are satisfied.  Otherwise, the       Incorporation, etc. This field is required. 
document must be amended in accordance with the applicable         
provisions of this title or, if the document relates to the       3.  The date is the date the document sought to be abandoned 
formation of an entity, the existence of the entity may be        was delivered to the Department for filing. This field is 
terminated in accordance with the applicable provisions of        required. 
law. A Statement of Correction may not be used as an               
alternative to the dissolution process. Thus, a Statement of      4.  Identify the inaccuracy or defect to be corrected. This 
Correction may not be used to strike the original public          should identify the defective document by specifying its name 
organic record (such as Articles of Incorporation) from the       and DSCB form number, the filing date of the defective 
records of the Department.  See 15 Pa.C.S. § 138(b)(2).           document and a statement of the defect to be corrected.  
                                                                  This field is required. 
Attachments                                                        
The following, in addition to the filing fee, shall               Signature and Verification 
accompany this form:                                              The Statement of Correction must be signed by the association 
 (1)  One copy of a completed form DSCB:15-134B                   or other person that delivered the inaccurate, erroneous or 
     (Docketing Statement - Changes) with respect to              defective document for filling. Signing a document delivered 
     each form, if any, which accompanied the original            to the Department for filing is an affirmation under the 
     filing.                                                      penalties provided in 18 Pa.C.S. § 4904 (relating to unsworn 
                                                                  falsification to authorities) that the facts stated in the 
                                                                  document are true in all material respects. This field is 
Form Instructions                                                 required. 
Enter the name and mailing address to which any 
correspondence regarding this filing should be sent.  This field 
must be completed for the Bureau to return the filing. If the 






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