(Rev. 10-09)                                      COMMONWEALTH OF PENNSYLVANIA                            
                                                                                DEPARTMENT OF STATE                                          
                                                              717-783-1720 BUREAU OF CHARITABLE ORGANIZATIONS                        
                                                                             1-800-732-0999 (WITHIN PA) 207 NORTH OFFICE BUILDING                     
                                                                                  FAX 717-783-6014      HARRISBURG, PA  17120                             
                                                                                                                      
                             NON-RENEWAL NOTICE FORM - BCO-2 
            (PERTAINS TO THE FILING OF REGISTRATION STATEMENT-FORM BCO-10 REQUIRED BY  
                          THE SOLICITATION OF FUNDS FOR CHARITABLE PURPOSES ACT) 
                                                                                                                      
                  Employer Identification # ____________________Certificate # ________________ 
  
 Official name, phone #, and principal address of charitable organization:                   
  
 † Check if name or address below is a change  
  
                         (FullOfficial                                     Name)       (Phone #)                                                           
  
 (Address)                                                                                                   (City)                (State)                              (Zip Code) 
  
 If not required to file registration please,                              state the exemption from registration or the exclusion from the Act that is 
 applicable. If the organization has been dissolved, please give date and attach supporting documentation. Be aware that 
an organization is required to renew its registration for each fiscal year the organization was engaged in 
solicitation activities in Pennsylvania and is not otherwise exempt or excluded from registration. 
 
    We are not required to file registration for the fiscal year that ended: ______/______/______.                                              
     
    Reason:  ______________________________________________________________________________________ 
     
    ______________________________________________________________________________________________ 
                         
  Company Name and Address of individual completing Form BCO-2 (if different than above): 
   
    ______________________________________________________________________________________________ 
     
    ______________________________________________________________________________________________ 
     
    Signature                                                                                      Phone # of signatory         
     
    Print Name of signatory                                                                                                       Date