Read all instructions prior to completing. This registration expires on December 31 of each year
and must be renewed annually
between October 1 and December 31.
Fee: $70
Check one: Initial registration Renewal of registration
In compliance with the requirements of 54 Pa.C.S. § 502 (b) and (d) (relating to certain additions to register), the
undersigned domestic unincorporated association, desiring to register with the Department of State the name under which
it is doing business or operating, hereby states that:
1. The name to be registered is: ________________________________________________________________
2. The address of the association is:
Number and street City State Zip County
3. The length of time, if any, during which the name has been used by the applicant is: ____________________
IN TESTIMONY WHEREOF, the undersigned domestic unincorporated association has caused this Application for
Registration of Unincorporated Association Name to be signed by a duly authorized officer this
day of
, 20 .
Name of Domestic Unincorporated Association
Return document by mail to:
City State Zip Code
Return document by email to: _________________________________
Pennsylvania Department of State
Bureau of Corporations and Charitable Organizations
P.O. Box 8722
Harrisburg, PA 17105-8722
(717) 787-1057
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 to the
address stated above.
Who should file this form?
Any domestic unincorporated association seeking to register
an association name for a period of up to one year may file
this form. This form is only to be used when the association is
not otherwise required to be formed or organized by another
type of filing. This registration will NOT formally incorporate,
organize or form an association. See the Department’s
Registration Forms
page for necessary forms. This form also
will NOT register a d/b/a or fictitious name. Use DSCB:54-
311 (Registration of Fictitious Name).
Available names will be registered though December 31 of the
year in which the registration is filed. Registrations may be
renewed annually between October 1 and December 31 for the
following calendar year. Initial registrations filed between
October 1 and December 31 will expire on December 31 of
the following calendar year.
Applicable Law
For registration of name of unincorporated association, 54
Pa.C.S. § 502; for names, in general, 15 Pa.C.S. §§ 201-209.
Statutes are available on the Pennsylvania General Assembly
, by following the link for
Association Name Requirements
Generally, the name of an association may not be the same as
the name of another association which is already on the
records of the Department of State. A name registered using
this form may NOT use certain designators indicating it is
incorporated or has limited liability (e.g. Inc., LLC, Limited,
Restricted word and/or approvals:
Association names may not contain words, phrases or
abbreviations prohibited or restricted by statute or regulation,
unless in compliance with the restriction, generally with the
consent or approval of a government agency, board or
commission. These may include certain professional and
occupational boards or commissions of the Bureau of
Professional and Occupational Affairs, the Department of
Education, the Department of Banking and Securities, the
Insurance Department or the Public Utility Commission.
There are also words and abbreviations that may be restricted,
prohibited, or may be permitted in certain instances as
provided in various federal statutes, Attorney General
opinions and Bureau regulations.
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 filing. 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 email
or mailing addresses provided on this form will become part
of the filed document and therefore public record.
Indicate whether the application is an initial registration or
whether the application is being renewed. Renewals must be
submitted for filing between October 1 and December 31 for
the following calendar year.
1. Give the exact name of the association. This should include
the exact spelling and punctuation. This field is required.
2. The street and mailing address of the association’s
principal office. This address should be located in this
Commonwealth. Post office boxes are not acceptable for any
address. Under 15 Pa.C.S. § 135(c) (relating to addresses), an
actual street or rural route box number must be used 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.
3. The length of time which the registrant has used the name.
An exact date is preferred but not required.
Signature and Verification
An authorized representative of the domestic association must
sign 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