19 Pa. Code § 95.101 – Official forms.

FORMS

The following official forms have been promulgated under this chapter and appear in Appendix A:

Form DSCB:UCC-1 (Uniform Commercial Code-Financing Statement).

Form DSCB:UCC-3 (Uniform Commercial Code-Financing Statement Change).

Form DSCB:UCC-11 (Uniform Commercial Code-Request for Information or Copies).

Source

The provisions of this § 95.101 adopted April 17, 1992, effective April 18, 1992, 22 Pa.B. 1993.

(Editor’s Note: Appendix A reserved October 5, 2001, effective October 6, 2001, 31 Pa.B. 5621.)

APPENDIX A. [Reserved]

Source

The provisions of this Appendix A reserved October 5, 2001, effective October 6, 2001, 31 Pa.B. 5621. Immediately preceding text appears at serial pages (278699) to (278956).

APPENDIX B. [Reserved]

Source

The provisions of this Appendix B adopted October 5, 2001, effective October 6, 2001, 31 Pa.B. 5621; amended February 18, 2011, effective February 19, 2011, 41 Pa.B. 985; amended May 10, 2013, effective May 11, 2013, 43 Pa.B. 2687; amended October 25, 2013, effective October 26, 2013, 43 Pa.B. 6469; reserved June 12, 2015, effective July 1, 2015, 45 Pa.B. 2973. Immediately preceding text appears at serial pages (374641), (374642), (368555), (368556), (356223), (284505), (284506), (356117) to (356122), (366607) to (366612), (284519) to (284524), (356125), (356127), (356128), (284529), (284530), (366613), (366614), (284533) to (284536), (368557) to (368560), (284541) to (284546), (371611), (371612), (284547) to (284550), (356129) to (356132), (284555) to (284598), (366615) to (366618), (284603), (284604), (356133), (356134), (284607) to (284610), (356135) to (356138), (368561) to (368564), (366623) to (366626), (356141), (356142), (284621) to (284638), (356143) to (356145), (284643) to (284646), (374643) to (374648), (284653), (284654), (366627), (366628), (284659) to (284664), (356147) to (356149), (374649) to (374652), (284673) to (284696), (356151) to (356154), (284701), (284702), (368565), (368566), (284707) to (284722), (368567) to (368571), (366629), (366630) and (356227) to (356240).

APPENDIX C. OFFICIAL FORMS DSCB form number Form name Title 15 forms 15-108 Statement of Change of Registered Office by Agent…Appx. 7 15-133/145/153 Copy/Certification Request…Appx. 10 15-134A Docketing Statement—New Entity…Appx. 12 15-134B Docketing Statement—Changes…Appx. 13 15-138 Statement of Correction…Appx. 15 15-141 Statement of Abandonment…Appx. 17 15-146Annual Report … Appx. 18.1 15-146(f)Annual Report Update…Appx. 18.7 15-152(1) Preclearance of Document…Appx. 19 15-153(a)(15) Expedited Service Request…Appx. 20 15-153(a)(17) Special Processing…Appx. 21 15-154 Statement of Unpaid Fee…Appx. 22 15-161 Statement of Domestication—Other…Appx. 23 15-208 Name Reservation/Transfer of Reservation…Appx. 26 15-209 Application for Registration of Name of Nonregistered Foreign Association…Appx. 29 15-210Registration of Name of Domestic Nonfiling Association…Appx. 31.1 15-335 Statement of Merger…Appx. 32 15-335AD Statement of Merger—Addendum…Appx. 39 15-345 Statement of Interest Exchange…Appx. 41 15-355 Statement of Conversion…Appx. 46 15-366 Statement of Division…Appx. 52 15-366AD Statement of Division—Addendum…Appx. 59 15-375 Statement of Domestication…Appx. 61 15-412 Foreign Registration Statement…Appx. 66 15-413 Amendment of Foreign Registration…Appx. 71 15-415/417 Statement of Withdrawal of Foreign Registration…Appx. 74 15-418 Transfer of Foreign Registration…Appx. 78 15-1306/2102/ 2303/2702/2903/ 3101/3303/7102 Articles of Incorporation—For Profit…Appx. 82 15-1311/5311/9305 Statement of Summary of Record…Appx. 85 15-1341/5341 Statement of Revival—Domestic Corporation…Appx. 89 15-1507/5507/ 8625/8825 Change of Registered Office…Appx. 92 15-1522 Statement with Respect to Shares—Domestic Business Corporation…Appx. 94 15-1902/5902 Statement of Termination—Domestic Corporation…Appx. 97 15-1915/5915 Articles of Amendment—Domestic Corporation…Appx. 99 15-1971/5971 Voluntary Dissolution [Never Transacted Business] Domestic Corporation …Appx. 102 15-1977/5977 Articles of Dissolution—Domestic Corporation…Appx. 105 15-1989/5989 Articles of Involuntary Dissolution—Domestic Corporation…Appx. 109 15-2104/2305 Articles of Amendment—Domestic Business Corporation—Election of Nonstock/ Statutory Close Status…Appx. 112 15-2309A/2309B Breach/Cure of Qualifying Condition/Domestic Business/Statutory Close Corporation …Appx. 115 15-2704/2904/3304 Articles of Amendment—Domestic Business Corporation—Election of Management/ Professional/Benefit Status…Appx. 118 15-2905 Statement of Election of Professional Corporation Status…Appx. 121 15-3331 Annual Benefit Report—Benefit Corporation …Appx. 123 15-5110 Annual Statement—Nonprofit Corporation…Appx. 126 15-5306/7102 Articles of Incorporation—Nonprofit…Appx. 128 15-7104/7105/ 7106/7107 Articles of Amendment—Election/Termination of Cooperative Corporation Status…Appx. 132 15-8201A Statement of Registration—Domestic Limited Liability Partnership…Appx. 135 15-8201B/8201C Statement of Amendment/Termination—Domestic Limited Liability Partnership…Appx. 138 15-8205 [Reserved] …Appx. 142 15-8221/8998 Certificate of Annual Registration…Appx. 143 15-8433Certificate of Partnership Authority…Appx. 146 15-8434Certificate of Denial—General Partnership…Appx. 150 15-8474/8665Certificate of Dissociation as Partner…Appx. 152 15-8482(b)(2)(i)Certificate of Dissolution—Domestic General Partnership…Appx. 154 15-8482(b)(2)(vi)Certificate of Termination—Domestic General Partnership…Appx. 156 15-8515 [Reserved] …Appx. 158 15-8519 [Reserved] …Appx. 159 15-8621 Certificate of Limited Partnership…Appx. 160 15-8622/8822 Certificate of Amendment—Domestic—Limited Partnership/Limited Liability Company…Appx. 163 15-8636Certificate of Negation…Appx. 167 15-8681.1Voluntary Termination [Never Transacted Business]—Domestic Limited Partnership…Appx. 169 15-8682(e)Certificate of Termination—Limited Partnership…Appx. 171 15-8701A/8701B/ 8701C Statement of Election—Partnership—Election/ Amendment/Termination…Appx. 173 15-8821 Certificate of Organization—Domestic Limited Liability Company…Appx. 176 15-8832Certificate of Limited Liability Company Authority…Appx. 180 15-8833Certificate of Denial—Limited Liability Company…Appx. 184 15-8872(b)(2)(i)Certificate of Dissolution—Domestic Limited Liability Company…Appx. 186 15-8872(f) Certificate of Termination—Domestic Limited Liability Company…Appx. 188 15-8878Voluntary Termination [Never Transacted Business] Domestic Limited Liability Company …Appx. 190 15-8898Annual Benefit Report—Benefit Limited Liability Company…Appx. 192 15-9120 Unincorporated Nonprofit Association—Agent for Service of Process—Appointment/Amendment/Cancellation…Appx. 195 15-9120D Unincorporated Nonprofit Association— Resignation of Agent for Service of Process…Appx. 198 19 Pa. Code forms 19-17.2 Consent to Appropriation of Name…Appx. 200 Title 54 forms 54-311 Registration of Fictitious Name…Appx. 202 54-312/313 Fictitious Name—Amendment, Withdrawal, Cancellation…Appx. 205 54-502 Registration or Renewal of Unincorporated Association Name…Appx. 209 54-503 Decennial Report of Association Continued Existence…Appx. 211 54-506 Statement of Termination of Registration of Association Name…Appx. 213 54-1112 Registration of Trademark or Service Mark…Appx. 215 54-1114/1115 Trademark/Service Mark—Renewal or Assignment …Appx. 219 54-1311/1312 Insignia—Registration or Amendment…Appx. 223 54-1314/1515 Decennial Report—Insignia or Mark Used with Articles or Supplies…Appx. 226 54-1511/1512 Mark Used with Articles or Supplies— Registration or Amendment…Appx. 228 Title 13 forms UCC1 Uniform Commercial Code— Financing Statement…Appx. 231 UCC1Ad Uniform Commercial Code— Financing Statement Addendum…Appx. 233 UCC1AP Uniform Commercial Code— Financing Statement Additional Party…Appx. 235 UCC3 Uniform Commercial Code— Financing Statement Amendment…Appx. 237 UCC3Ad Uniform Commercial Code— Financing Statement Amendment Addendum…Appx. 239 UCC3AP Uniform Commercial Code— Financing Statement Amendment Additional Party…Appx. 241 UCC5 Information Statement…Appx. 243 UCC11 Information Request…Appx. 245

Source

The provisions of this Appendix C adopted June 12, 2015, effective July 1, 2015, 45 Pa.B. 2973, unless otherwise noted.

108-1

108-2

108-3

1112-1

1112-2

1112-3

Source

The provisions of this form DSCB:15-134A amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial page (377154).

1112-4

1112-5

Source

The provisions of this form DSCB:15-134B amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465. Immediately preceding text appears at serial pages (377155) to (377156).

1114-1

1989-1

1114-2

1114-3

Form 1

Form 2

Form 3

Form 4

Form 5

Form 6

Source

The provisions of this Form DSCB:15-146 added December 13, 2024, effective January 1, 2025, 54 Pa.B. 8207.

Form 7

Form 8

Form 9

Form 10

Form 11

Form 12

Source

The provisions of this Form DSCB:15-146(f) added December 13, 2024, effective January 1, 2025, 54 Pa.B. 8207.

1114-4

1306-1

1306-2

Source

The provisions of this form DSCB:15-153(a)(17) amended February 24, 2017, effective March 1, 2017, 47 Pa.B. 1250. Immediately preceding text appears at serial page (377163).

1306-3

1311-1

1311-2

1311-3

5311-1

5311-2

5311-3

5311-4

1314-2

1314-3

Source

The provisions of this form DSCB:15-209 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377171) to (377173).

15-210-1

15-210-2

Source

The provisions of this Form DSCB:15-210 added September 13, 2024, effective September 13, 2024, 54 Pa.B. 5953.

1341-1

1341-3

15134a-1

15134b-1

138-1

138-2

138-3

1507-1

1507-2

1507-3

1511-1

1511-2

1511-3

1522-1

1522-2

1522-3

1923-36

161-1

161-3

161-4

162f-1

162f-2

162g-1

162g-2

17.2-1

17.2-2

1902-1

1902-2

1902-3

1915-1

1915-2

1915-3

1926-1

1926-2

1926-3

1926-4

1926-5

Source

The provisions of this form DSCB:15-412 amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465; amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377694) to (377698).

162a-1

162a-2

162a-3

Source

The provisions of this form DSCB:15-413 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377213) to (377215).

162a-4

1931-1

1931-2

1931-3

1954-1

1954-2

1954-3

1954-4

Source

The provisions of this form DSCB:15-418 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377220) to (377223).

1954-5

1963-1

1963-2

Source

The provisions of this form DSCB:15-1306/2102/2303/2702/2903/3101/3303/7102 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377224) to (377226).

1963-3

1971-1

1971-2

1971-3

1977-1

1977-2

1977-3

1977-4

1989-1

Source

The provisions of this form DSCB:15-1507/5507/8625/8825 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377234) to (377235).

1989-2

1989-3

2104-1

2104-2

2104-3

2309a-1

2309a-2

2309a-3

2704-1

2704-2

2704-3

Source

The provisions of this form DSCB:15-1971/5971 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377244) to (377246).

2905-1

2905-2

2905-3

3.140-1

311-1

311-2

311-3

311-4

312-1

312-2

312-3

312-4

4124-1

4124-2

4124-3

4126-1

120.1

120.2

120.3

120.4

4126-2

Source

The provisions of this form DSCB:15-3331 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377265) to (377268).

4127-1

4127-2

4127-3

4128-1

4128-2

4128-3

Source

The provisions of this form DSCB:15-5306/7102 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377271) to (377274).

4128-4

4130-1

4130-2

4130-3

4131-1

4131-2

Source

The provisions of this Form DSCB:15-8201A amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377278) to (377280).

4161-1

4161-2

4161-3

4161-4

Source

The provisions of this form DSCB:15-8201B/8201C amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377281) to (377283).

Source

The provisions of this form DSCB:15-8205 reserved January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377284) to (377285).

502-1

502-2

503-1

Source

The provisions of this form DSCB:15-8221/8998 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567; amended March 22, 2019, effective March 23, 2019, 49 Pa.B. 1461; amended March 21, 2025, effective March 22, 2025, 55 Pa.B. 2400. Immediately preceding text appears at serial pages (395929) to (395931).

8433-1

8433-2

8433-3

8433-4

Source

The provisions of this DSCB:15-8433 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8434-1

8434-2

Source

The provisions of this DSCB:15-8434 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8474-1

8474-2

Source

The provisions of this form DSCB:15-8524/8532 renumbered as DSCB:15-8474/8665 and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377301) to (377302).

8482(b)(2)(i)-1

8482(b)(2)(i)-2

Source

The provisions of this DSCB:15-8482(b)(2)(i) adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8482(b)(2(vi)-1

8482(b)(2)(vi)-2

Source

The provisions of this DSCB:15-8482(b)(2)(vi) adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

Source

The provisions of this form DSCB:15-8515 reserved January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377295) to (377297).

Source

The provisions of this form DSCB:15-8519 reserved January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377298) to (377300).

8621-1

8621-2

8621-3

Source

The provisions of this Form DSCB:15-8511 renumbered as DSCB:15-8621 and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377288) to (377289).

8622-1

8622-2

8622-3

8622-4

Source

The provisions of this form DSCB:15-8512/8951 renumbered as DSCB:15-8622/8822 and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377290) to (377292).

8636-1

8636-2

Source

The provisions of this DSCB:15-8636 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8681.1-1

8681.1-2

Source

The provisions of this DSCB:15-8681.1 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8682(e)-1

8682(e)-2

Source

The provisions of this form DSCB:15-8513 renumbered as DSCB:15-8682(e) and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377293) to (377294).

1989-1

8201a-1

8201a-2

8201a-3

8201b-1

8201b-2

8201b-3

Source

The provisions of this form DSCB:15-8913 renumbered as DSCB:15-8821 and amended March 3, 2017, effective March 4, 2017, 47 Pa.B. 1444. Immediately preceding text appears at serial pages (377306) to (377308).

8832-1

8832-2

8832-3

8832-4

Source

The provisions of this DSCB:15-8832 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8833-1

8833-2

Source

The provisions of this DSCB:15-8833 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8872(b)(2)(i)-1

8872(b)(2)(i)-2

Source

The provisions of this DSCB:15-8872(b)(2)(i) adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8201b-3

8205-1

Source

The provisions of this form DSCB:15-8975 renumbered as DSCB:15-8872(f) and amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377309) to (377310).

8878-1

8878-2

Source

The provisions of this DSCB:15-8878 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8898-1

8898-2

8898-3

Source

The provisions of this DSCB:15-8898 adopted January 27, 2017, effective February 21, 2017, 47 Pa.B. 567.

8205-2

1752-30-14

1752-30-15

1989-1

8511-1

8511-2

1989-1

8512-1

8512-2

8512-3

Source

The provisions of this form DSCB:54-311 amended August 7, 2015, effective September 8, 2015, 45 Pa.B. 4465; amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377700) to (377702).

8513-1

8513-2

8513-3

8515-1

8515-2

8515-3

Source

The provisions of this form DSCB:54-502 amended January 27, 2017, effective February 21, 2017, 47 Pa.B. 567. Immediately preceding text appears at serial pages (377325) to (377326).

8519-1