Form DSCB:15-134A "Docketing Statement - New Entity" - Pennsylvania

What Is Form DSCB:15-134A?

Form DSCB:15-134A, Docketing Statement - New Entity, is a one-page form to register your new Pennsylvania LLC for tax purposes. This PA Docketing Statement is submitted to the Pennsylvania Department of Revenue for the purpose of assigning your LLC a Pennsylvania Tax ID number. This form must be submitted in conjunction with the Form DSCB:15-8821, Certificate of Organization. These are the two documents needed to officially form an LLC in Pennsylvania.

This DSCB:15-134A Form, is issued by the Pennsylvania Department of State and the latest revision took place on February 1, 2017. A DSCB:15-134A Form is available for download below.

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How to Fill Out Form DSCB:15-134A?

Follow the DSCB:15-134A instructions below to complete the form.

  1. For Entity Name, enter the name of your LLC, exactly as it is on your Certificate of Organization. Before choosing an LLC name for both of these documents, make sure the LLC name is available by checking the PA State government website;
  2. For Tax Responsible Party, enter the name, street, city, state, zip, and county of the "primary member's" name. The only people who can be members of an LLC is the owner of the LLC and any others who agree to go into business with the owner. This will be your name and address for most filers. All states allow single-member LLCs.;
  3. For Description of Business Activity, enter at least a few words or sentences to describe what the business will do. It does not have to be very specific or technical. If the business will conduct multiple activities, enter the primary activity. This section is just for initial information for the Department of Revenue. Do not enter any general LLC purpose statement, otherwise, the document will be rejected;
  4. Regarding the FEIN (Employer Identification Number/Federal Tax Identification Number), one can apply online. It is recommended however to leave this section blank and apply for your Federal Tax ID Number after your LLC is approved. If this number is left blank, the state will still accept the document;
  5. For the FYE (Tax Year or Fiscal Year End) enter 12/31 if your business calendar year is January 1 to December 31. If your business reporting cycle does not end on 12/31, enter your business fiscal year-end date;
  6. This form does not require a signature. Once these steps are completed it is ready to submit along with the completed Certificate of Organization Form DSCB: 15-8821.
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Download Form DSCB:15-134A "Docketing Statement - New Entity" - Pennsylvania

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PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Docketing Statement – New Entity
DSCB:15-134A
(rev. 2/2017)
1. Entity Name:
In the case of a foreign association which must use an alternate name to register to do business in Pennsylvania, the
alternate name should be given.
2. Tax Responsible Party
Name of individual responsible for initial tax reports: ______________________________________________________
Mailing address of individual responsible for initial tax reports:
__________________________________________________________________________________________________
Number and street
City
State
Zip
County
3. Description of Business Activity:
__________________________________________________________________________________________________
__ __ - __ __ __ __ __ __ __
4. FEIN [Employer Identification Number/Federal Tax Identification Number]:
FEIN enables agencies to confirm that Commonwealth accounts are properly matched and that this request is processed
without added delay. If the business entity does not currently have an FEIN, it can get a FEIN immediately by applying
online at irs.gov at the following page
http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Employer-ID-
Numbers-EINs.
5. FYE [Tax Year or Fiscal Year End]:
__ __ /__ __
Month / Day
A fiscal year (FY) is a period that a company or government uses for accounting purposes and preparing financial
statements. For tax purposes, the Internal Revenue Service (IRS) allows companies to be either calendar-year taxpayers or
fiscal-year taxpayers. Supply month and day for intended tax year end, e.g. 1/31, 2/28, 3/31, 4/30, 5/31, 6/30, 7/31, 8/31,
9/30, 10/31, 11/30 or 12/31.
PENNSYLVANIA DEPARTMENT OF STATE
BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS
Docketing Statement – New Entity
DSCB:15-134A
(rev. 2/2017)
1. Entity Name:
In the case of a foreign association which must use an alternate name to register to do business in Pennsylvania, the
alternate name should be given.
2. Tax Responsible Party
Name of individual responsible for initial tax reports: ______________________________________________________
Mailing address of individual responsible for initial tax reports:
__________________________________________________________________________________________________
Number and street
City
State
Zip
County
3. Description of Business Activity:
__________________________________________________________________________________________________
__ __ - __ __ __ __ __ __ __
4. FEIN [Employer Identification Number/Federal Tax Identification Number]:
FEIN enables agencies to confirm that Commonwealth accounts are properly matched and that this request is processed
without added delay. If the business entity does not currently have an FEIN, it can get a FEIN immediately by applying
online at irs.gov at the following page
http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Employer-ID-
Numbers-EINs.
5. FYE [Tax Year or Fiscal Year End]:
__ __ /__ __
Month / Day
A fiscal year (FY) is a period that a company or government uses for accounting purposes and preparing financial
statements. For tax purposes, the Internal Revenue Service (IRS) allows companies to be either calendar-year taxpayers or
fiscal-year taxpayers. Supply month and day for intended tax year end, e.g. 1/31, 2/28, 3/31, 4/30, 5/31, 6/30, 7/31, 8/31,
9/30, 10/31, 11/30 or 12/31.