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PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Read all instructions prior to completing. This form may be submitted online at https://www.corporations.pa.gov/. Fee: $70 Check One: Name Reservation Transfer of Name Reservation In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 208 (relating to Reservation of name), the undersigned hereby states that: 1. The name to be reserved/transferred is: _______________________________________________________________ 2. The name of the person or association reserving/transferring the name is: __________________________________________________________________________________________________ 3. The address of the person or association reserving/transferring the name is: ___________________________________________________________________________________________________________ Number and street City State Zip Co de For TRANSFER of Name Reservation ONLY 4. The name of the person or association to whom the name reservation is being transferred is: __________________________________________________________________________________________________ 5. The address of the person or association to whom the name reservation is being transferred is: __________________________________________________________________________________________________________ Number and street City State Zip Co de IN TESTIMONY WHEREOF, the undersigned person or association has caused this Name Reservation/Transfer of Reservation to be signed this ______________ day of ____________________________ , 20________ . ___________________________________________________ Name of Applicant/Transferor* ___________________________________________________ Applicant/Duly authorized representative/Transferor Signature (A transfer of name reservation must be signed by the person who initially reserved the name.) ___________________________________________________ Title (for association applicant only) Return document by mail to: Name Address City State Zip Code Return document by email to: _________________________________ Name Reservation/Transfer of Reservation DSCB:15-208 (7/1/2015) *208* 208 DSCB:15-208–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 Information  Typewritten is preferred.  If handwritten, the form  must be  legible and completed in black or blue-black ink in  order to  permit reproduction.  The nonrefundable filing fee  for this  form is $70.       Checks should be made payable to the Department of  State.   Checks must contain a commercially pre-printed name  and  address.    This form and all accompanying documents, including  any  necessary governmental approvals, shall be mailed t o the  address stated above.   Available names will be reserved for a period of 12 0 days.   Bank name reservations will be reserved for a perio d of six  months.      NOTE: The online and customer service name availabi lity  search function only performs a preliminary search  of  availability in the Bureau’s database. Upon receipt  of a  registration request, the Bureau will perform a det ailed search  and confirm whether or not the requested name is av ailable.  Do not have signs, business cards, bank accounts or  contracts  established in the requested business name prior to  obtaining  official confirmation of acceptance of the filing f rom the  Bureau.   This form only provides for a single, one-time rese rvation of a  name. After the 120-day reservation period expires,  the name  becomes available again and anyone, including the o riginal  reserver, may reserve the name.  Nothing prevents t he  formation of an association for the purpose of hold ing a name  if a longer period of reservation is desired than t he 120-day  period permitted by 15 Pa.C.S. § 208.    Who should file this form?  Any individual or association seeking to reserve an  association  name for a period of 120 days may file this form. F ictitious  names may not be reserved because they do not have  name  exclusivity.     Applicable Law  For name reservations, in general, 15 Pa.C.S. § 208 ; for  names, in general, 15 Pa.C.S. § 414 and §§ 201-209.  Statutes  are available on the Pennsylvania General Assembly  website,  www.legis.state.pa.us , by following the link for Statutes.    Assocation Name Requirements  Association designators are not required to reserve  an  association name.  Generally, the name of an associ ation may not be the same as the name of another association  which is  already on the records of the Department of State.  A domestic  filing entity, a domestic limited liability partner ship, an  electing partnership, a registered foreign associat ion or an  association registered at any time under 54 Pa.C.S.  Ch. 5  (relating to corporate and other association names)  may  consent to the use of its name. See DSCB:19-17.2 (C onsent to  Appropriation of Name) for consent requirements.      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.      Form Instructions  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 fili ng. 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 e mail  or mailing addresses provided on this form will bec ome part  of the filed document and therefore public record.   1.    Give the name of the association to be reserved.     An association designator is not required to be par t of the  reserved name. For domestic filing entity name requ irements,  see 15 Pa.C.S. §§ 201-207. For foreign association  name  requirements, see 15 Pa.C.S. § 412 and   § 414.  Statutes are available on the Pennsylvania  General  Assembly website,  www.legis.state.pa.us , by following the  link for Statutes.  This field is required.      2.   Give the name of the person or association reques ting the  name reservation. Under the definition of “person”  in 1  Pa.C.S. § 1991, a corporation, partnership, or othe r  association, as well as a natural person, may reser ve an  association name.  This field is required.     3.   Give the address of the person or association req uesting the  name reservation. Post office boxes are not accepta ble for any  address. Under 15 Pa.C.S. § 135(c) (relating to add resses), an  actual street or rural route box number must be use d 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.  This field is required.     DSCB:15-208–Instructions    4.  Give the name of the person or association to whom  the  reservation is transferred.  This field is required for Transfer  of Name Reservation only.     5.   Give the address of the person or association to  whom the  reservation is transferred.  This field is required for Transfer  of Name Reservation only.     Signature and Verification  The person or an authorized representative of the a ssociation  reserving the name must sign the Name Reservation.  A  Transfer of a Name Reservation must be signed by th e  transferor (the individual or association that init ially reserved  the name). A Transfer of a Name Reservation may not  be  signed by the transferee (the person to whom the na me is  transferred).    Signing a document delivered to the Department for  filing is  an affirmation under the penalties provided in 18 P a.C.S.   § 4904 (relating to unsworn falsification to author ities) that the  facts stated in the document are true in all materi al respects  This field is required.  

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