PENNSYLVANIA DEPARTMENT OF STATE 
 BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS       
                                                                                                                     
       Return document by mail to:                                                             
                                                                                                         Statement of Registration 
   
                                                                                               Domestic  Registered Limited Liability Partnership 
  Name 
                                                                                                                                                                                                                     DSCB:15-8201A     (rev. 7/2015) 
  Address                                                                                                            
   
  City                                             State                             Zip Code            *8201*  
   
                                                                                                                    8201 
       Return document by email to: _________________________________ 
  
                                                   Read all instructions prior to completing.  
  
 Fee:  $125 
  
          In compliance with the requirements of 15 Pa.C.S. § 8201 (relating to statement of registration), the undersigned 
desiring to register a domestic registered limited liability partnership, hereby certifies that: 
  
       1. The name of the domestic registered limited liability partnership (designator is required, i.e., 
  
       “company”, “limited” or “limited liability partnership” or abbreviation): 
        
       2.  Complete one of the following: 
        
              The partnership is a general partnership and the address, including number and street, if any, of its 
             principal place of business:  
        
             Number and street                                              City                       State                     Zip               County 
        
              The partnership is a limited partnership and the (a) address of its current registered office in this 
             Commonwealth or (b) name of its commercial registered office provider and the county of venue is: 
  
             (Complete (a)  or(b), not both) 
  
          (a) Number and Street                        City                              State                       Zip                      County 
              
       c/o: 
          (b) Name of Commercial Registered Office Provider                                                                       County  
        

DSCB:15-8201A-2 
 
     3.   The general/limited (strike out inapplicable term) partnership registers under 15 Pa.C.S. Subchapter 82A. 
 
     4.  The registration has been authorized by at least a majority in interest of the partners. 
 
                               IN TESTIMONY                           WHEREOF, the undersigned 
                               general                       partner of the domestic registered limited 
                                                             
                               liability partnership has executed this Statement of  
                                                             
                               Registration                      this 
                                
                                                             day of                                          ,                       . 
                                                             
                               _______________________________________________ 
                                                                            Name 
                                                             
                                                                        Signature 
                                                                             
                                _____________________________________________ 
                                                                            Title 
                                                             

DSCB:15-8201A–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 Instructions for Completion of Form: 
 
A.  Typewritten is preferred.  If handwritten, the form shall be legible and completed in black or blue-black ink in 
 order to permit reproduction.  The nonrefundable filing fee for this form is $125 made payable to the Department 
 of State.  Checks must contain a commercially pre-printed name and address. 
 
 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 filing is to be returned by email, an email address must be 
 provided. An email will be sent to address provided, containing a link and instructions on how a copy of the filed 
 document or correspondence may be downloaded. Any email or mailing addresses provided on this form will become 
 part of the filed document and therefore public record. 
 
B.  The status of being a registered limited liability partnership is available for either general partnerships or limited 
 partnerships. For a general partnership registering as a limited liability partnership, prior registration with the 
 Department of State as a general partnership is not required.  For a limited partnership registering as a limited liability 
 partnership, the limited partnership must be an existing limited partnership filed with Department of State in order to 
 use this form.  
 
C.  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.  A general partnership or a limited partnership may file a Statement of Registration to register as a 
 limited liability partnership.  For a general partnership, the address should be set forth in the first part of Paragraph 2.  
 For a limited partnership, the address should be set forth in the second part of Paragraph 2. 
 
D.  The following, in addition to the filing fee, shall accompany this form: 
 
 (1)  Any necessary copies of form DSCB:19-17.2 (Consent to Appropriation of Name). 
 (2)  Any necessary governmental approvals. 
 
E.  This form shall be executed by a general partner.  Any natural person of full age, corporation, partnership, limited 
 liability company, business trust, other association, government entity (other than the Commonwealth), estate, trust or 
 foundation may be designated as a general partner in the general partnership or limited partnership which is 
 registering and may execute this form.   
 
F. This form and all accompanying documents shall be mailed to the address stated above.