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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.Pa.C.S. § 1905 or § 5905. Complete and file the Certificate of Dissolution with the Department of State. Complete and include this form with your paper submission. Enter the name and address to return an acknowledgement copy of this form to. This must be a physical address. Principal office mailing address. HOW WAS THE DISSOLUTION APPROVED: Complete the information as required. If membership approval was not required, check the appropriate section.