Form Dscb:15-134b - Docketing Statement (Changes)
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1
2Docketing Statement (Changes)
BUREAU USE ONLY:
DSCB:15-134B
Revenue
Labor & Industry
Other _____________________
File Code_________ Filed Date ____________
Part I. Complete for each filing:
Current name of entity or registrant (survivor or new entity if merger or consolidation):
Entity number, if known:
Incorporation/qualification date in PA:
State of Inc:
Federal EIN:
Specified effective date, if any:
Part II. Check proper box:
Amendment (complete Section A)
Merger, Consolidation or Division (complete Section B,C or D)
Consolidation (complete Section C)
Division (complete Section D)
Conversion (complete Section A & E)
Correction (complete Section A)
Termination (complete Section H)
Revival (complete Section G)
Dissolution before Commencement of Business (complete Section F)
Section A – Check box(es) which pertain to changes:
Name:
Registered Office: Number & street/RD number & box number City
State
Zip
County
Purpose:
Stock (aggregate number of share authorized):
Effective date:
.
Term of Existence:
Other:
.
Section B – Merger Complete Section A if any changes to surviving entity:
Merging Entities are: (attach sheet for additional merging entities)
DSCB:15-134B-2
Name:
Entity #, if known:
DSCB:15-134B-2
Effective date:
Inc./qual. date in PA.
State of Inc.
Name:
Entity #, if known:
Effective date:
Inc./qual. date in PA.
State of Inc.
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