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Ocument will be returned to the name and address you enter to the left. Address City State Zip Code Fee: $70 In compliance with the requirements of the applicable provisions of 15 Pa.C.S. (relating to corporations and unincorporated associations), the undersigned qualified foreign corporation, desiring to withdraw from doing business in this Commonwealth, hereby states that: 1. The name of the corporation is: 2. The (a) address of this corporation s current registered office in this.

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