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PENNSYLVANIA DEPARTMENT OF STATE 
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS       Return document by mail to:                                                                   
                                                                                                 
 Name 
                                                                                                                                                                                                                                                                                                                                                                                                     
 Address 
  
 City                                                State                             Zip Code 
  
  Return document by email to: _________________________________ 
                                                                                                                                                                  
                                                     Read all instructions prior to completing.  
Fee:  $125                                      I qualify for a veteran/reservist-owned small business fee exemption (see instructions) 
 
          In compliance with the requirements of 15 Pa.C.S. § 8201 (relating to statement of registration), the undersigned 
general partnership or limited partnership, desiring to register as domestic limited liability partnership or limited liability 
limited partnership, hereby certifies that: 
 
1.  The name of the domestic limited liability partnershipor                                    limited liability limited partnership is    (designator is required, 
     i.e., “company,” “limited” or “limited liability partnership” or abbreviation): 
 
2.  Check and 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 is:  
       
           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  
 
3.   The general/limited (strike out inapplicable term) partnership registers under 15 Pa.C.S. Chapter 82 Subchapter A. 
 
4.  The registration has been authorized by at least a majority in interest of the partners. 
 
 5.  Effective date of Statement of Registration (check, and if appropriate complete, one of the following): 
      The Statement of Registration shall be effective upon filing in the Department of State. 
      The Statement of Registration shall be effective on: _________________________ at __________________. 
                                                                                                 Date (MM/DD/YYYY)                          Hour (if any) 
IN TESTIMONY WHEREOF, the undersigned general partner of the domestic limited liability partnership/limited 

liability limited partnership has executed this Statement of                                    Registration this ______ day of _______________, ________. 
                                                          ________________________________________________________ 
                                                          Name 
                                                           
                                                          ________________________________________________________ 
                                                          Signature 
                                                           
                                                          ________________________________________________________ 
                                                          Title 



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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 
                                                  Website: www.dos.pa.gov/corps 
 
                                                                      (1) a statement of registration under Chapter 82; 
General Information 
Typewritten is preferred.  If handwritten, the form must be           (2) a provision of its certificate of limited partnership 
legible and completed in black or blue-black ink in order to        electing to be subject to Chapter 82; or 
permit reproduction.                                                  (3) a similar filing or provision under the organic law of a 
                                                                    foreign partnership. 
The nonrefundable filing fee for this form is $125. Checks           
should be made payable to the Department of State. Checks           Form Instructions 
must contain a commercially pre-printed name and address.           Enter the name and mailing address to which any 
Filers requesting a veteran/reservist-owned small business fee      correspondence regarding this filing should be sent.   
exemption should attach proof of the veteran’s or reservist’s       This field must be completed for the Bureau to return the 
status to the Statement of Registration form when submitted.        filing. If the filing is to be returned by email, an email address 
For more information on the fee exemption, see Fees and             must be provided. An email will be sent to address provided, 
Payments.                                                           containing a link and instructions on how a copy of the filed 
                                                                    document or correspondence may be downloaded. Any email 
This form and all accompanying documents, including any             or mailing addresses provided on this form will become part 
necessary governmental approvals, shall be mailed to the            of the filed document and therefore public record. 
address stated above.                                                
                                                                    1. Give the exact name of the limited liability partnership or 
Who should file this form?                                          limited liability limited partnership. The proper name of a 
The status of being a limited liability partnership is available    domestic limited liability partnership must contain the term 
for either general partnerships or limited partnerships.  In the    “company,” “limited” or “limited liability partnership,” or an 
case of a limited partnership, the limited partners already         abbreviation of one of those terms. This field is required. 
enjoy limited liability, but registering will provide limited        
liability for the general partners.                                 2. Address. Under 15 Pa.C.S. § 135(c) (relating to addresses) 
                                                                    an actual street or rural route box number must be used as an 
For a general partnership registering as a limited liability        address, and the Department of State is required to refuse to 
partnership, prior registration with the Department of State as     receive or file any document that sets forth only a post office 
a general partnership is not required.  For a limited partnership   box address.   For a general partnership, the address of the 
registering as a limited liability limited partnership, the limited principal place of business should be set forth in the first part 
partnership must be an existing limited partnership filed with      of Field 2.  For a limited partnership, the registered office 
Department of State in order to use this form.                      address should be set forth in the second part of Field 2. The 
                                                                    registered office address may be a number and street address 
Registration under 15 Pa.C.S. § 8201 does not change the            or the name of a Commercial Registered Office Provider. 
basic form of organization of the registering partnership as        This field is required. 
either a general or limited partnership.                             
                                                                    3. The statement in this field is required. 
Applicable Law                                                       
For requirements on limited liability partnerships and limited      4. The statement in this field is required. 
liability limited partnerships, see 15 Pa.C.S. §§ 8201-8244.         
Statutes are available on the Pennsylvania General Assembly         5. Any date specified as the effective date of the Statement of 
website, www.legis.state.pa.us, by following the link for           Registration must be a future effective date (after the date and 
Statutes.                                                           time of its delivery to the Department). A specified effective 
                                                                    date may not be retroactive (prior to the date and time of the 
Definitions                                                         delivery of the Statement of Registration to the Department).  
A limited liability partnership is a domestic or foreign            If a delayed effective date is specified, but no time is given, 
general partnership for which there is in effect:                   then the time used will be 12:01 a.m. on the date specified. If 
 (1) a statement of registration under Chapter 82 (relating to      neither option for an effective date is checked, it will be 
limited liability partnerships and limited liability limited        presumed that no specified delayed effective date is intended 
partnerships); or                                                   and the document will be effective upon filing. This field is 
 (2) a similar filing under the organic law of a foreign            required. 
general partnership.                                                 
A limited liability limited partnership is a domestic or            Signature and Verification 
foreign limited partnership for which there is in effect:           This form must be signed by a general partner.  Any natural 



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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. Signing a document delivered to the 
Department for filing is an affirmation under the 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 
required. 
 
Attachments 
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. 






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