If you are an individual who has not formed any type of corporate entity, you should enter your name as It will appear on your insurance documents.
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1 Secretary Revised 12/1/13 D Pennsylvania Public Utility Commission %f, 400 North Street, Second Floor Harrisburg, PA ' // (717) A* ^/fx'j.j ^ '//). Application for Motor Common Carrier or Motor Contract Carrier of Household Goods in Use. tyf^ THIS APPLICATION IS REQUIRED TO REQUEST A CERTIFICATE OF PUBLIC CONVENIENCE (FOR COMMON CARRIERS) OR PERMIT (FOR CONTRACT CARRIERS) TO OPERATE AS A COMMERCIAL CARRIER OF HOUSEHOLD GOODS IN USE. i 1. Legal Name Of Applicant (Individual, Partnership or Corporation) If you are an individual who has not formed any type of corporate entity, you should enter your name as It will appear on your insurance documents. If you are filing for a partnership, but nof a limited liability partnership, the names of all partners must be entered on this line. Those names should be entered as they will appear on your insurance documents. This includes husbands and wives filing jointly. If you are filing for a corporate entity (corporation, limited liability company, or limited liability partnership), even if you are the sole shareholder member, you must enter the name exactly as it appears on the registration papers from the Corporation Bureau of the Pennsvivania Department of State. 2. Trade Name (Attach a copy of fictitious name registration if applicable) This is any name which you will be operating under which differs from the LEGAL NAME OF APPLICANT. A TRADE NAME is considered a FICTITIOUS NAME if the identity of the applicant cannot be readily determined. EXAMPLE: John Doe is the applicant and wants to use the name "Johnboy Trucking" as his trade name. People cannot readily determine that John Doe is the actual operator; therefore, the name is fictitious and must be registered as such. \Trade names such as "John Doe Trucking" or "J. Doe Trucking" are not considered fictitious and would not have to be registered. 3. Do you currently hold PUC Authority? X NO Previous Authority? NO If YES, at PUC No. A- 4. Are you a business entity registered with the PA Department of State? NO If NO, you must register (see checklist on how to register) If YES, provide your PA Corporation Bureau Entity ID Number (see checklist and indicate type of business entity registered)
2 5. Physical Address (do not use PO Box) 1210 Fitzgerald Street Street Address Philadelphia, PA City, State and Zip Code (267) Philadelphia Telephone Number County The address entered here should reflect the actual location of the business. This is the address the Commission needs in order to dispatch Enforcement Officers to inspect equipment. 6. Mailing Address (if different from Physical Address) Same as physical address. Street Address City, State and Zip Code This is the address to which the Commission will send all official documents issued by the Commission. If left blank, it will be assumed that the MAILING ADDRESS is the same as the PHYSICAL ADDRESS. 7. Attorney (if applicable) Justin Serianni, Esq. (215) Attorney's Name & Telephone Number for this Filing 232 South 4th Street, Suite 3R, Philadelphia, PA Attorney's Address An attorney's name should only be entered if an attorney is filing the application for a client and the application is being sent under the attorney's cover letter. 8. Does applicant hold interstate operating authority? X i No Yes, at No. 9. Describe the service area proposed by this application. (Use the space below or attach additional sheet if space provided is not sufficient). To transport as a common carrier, household goods in use between points in the Commonwealth of Pennsylvania. Examples: To transport as a common carrier, household goods in use between points in Mercer County.
3 To transport as a contract carrier for the XYZ Company, household goods in use, from points in Elk County to points in PA. 10. Certification: Applicant certifies that it is not now engaged in unauthorized intrastate transportation for compensation between points in Pennsylvania and will not engage in said transportation unless and until authorization is received from the Pennsylvania Public Utility Commission. Applicant further certifies that it understands the requirements of the Pennsylvania Public Utility Commission, especially as they relate to safety and insurance and that it may be subject to civil penalties, suspension or cancellation of the Certificate for failure to comply with Commission requirements. Applicant further certifies that it understands that it is subject to an annual assessment based upon its reported gross Pennsylvania intrastate revenues; said assessment to help defray expenses incurred in regulating Motor Common and Motor Contract Carriers of Household Goods in Use; and acknowledges that failure to report revenue and pay its annual assessment may result in civil penalties, suspension or cancellation of the certificate. Verification of Application l/we hereby state that the statement(s) made in this application is/are true and correct to the best of my/our knowledge and belief. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Olsi Dashi, Member of applieanl {Print Name) (Signature) t 3 ^ {Date) The verification of the application must be completed by the applicant appearing on Line 1 of the application by the named individual, all partners if a partnership, a member (if a limited liability company), or by the President or Secretary (if a corporation).
4 INTKLUCENT M O VI; RS 1210 Fitzgerald St. Philadelphia, PA June 6, 2015 To Whom This May Concern: Here is a list of all members to Intelligent Movers: 1. (99%) Olsi Dashi, Owner and Operator, 1210 Fitzgerald St. Philadelphia, PA (1%) Amanda Tancredi, Marketing and Advertisement, 408 Chews Landing Rd. Haddonfield, NJ Thank you, Olsi Dashi Phone:
5 Entity tt: Date FJted; 04/21/2014 Carol Aichele Secretary of the Commonwealth PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Certificate of Organization Domestic Limited Liability Company (15 Pa.C.S. 8913) Name Address Suite 302B, 301 Oxford Valley Road T-'ity" Yardley, PA Stale ZipCodc Document will be returned to tbe name and address you enter to (he Mt. Commofiwealth of Pennsylvania CERTIFICATE OF ORGANIZATION 3 Page{s) Fee: SI25 T14iI54i033 In compliance with the requirements of 15 Pa.C.S (relating to certificate of organization), the undersigned desiring to organize a limited liability company, hereby certifies that: 1, The name of the limited liability company (designator is required, i.e.. "company". "limited" or "limited liability company" or abbreviation) : 2. The (a) address of the limited liability company's initial registered office in this Commonwealth or (b) name of Us commercial registered office provider and the county of venue is: (a) Number and Street City State Zip Suite 302B, 301 Oxford Valley Road, Yardley, PA (b) Name of Commercial Registered Office Provider do: County Bucks County 3. The name and address, including street and number, if any, of each organizer is (all organizers must sign on page 2): Name Address John F. Byrne, Jr. & Co, LLC Suite 302B, 301 Oxford Valley Rd., Yardley, PA PA DEPT. OF STATE APR 21 20M
6 STga I pc DEPARTMENT 01-' THK TREASURY vg&lfl IIXO j jj-fei^^ij REVENUK SERVICE DZILO of Lhis nouicf.-: OS-OV-SOH Employur IdunL i f icat: ion NLimbcf; i6-552v0-15 Komi: SS--} Un'F.U.TGBMT HOVERS M/J Qt.,S: DASH! MBR 1210 F'ITZGiSRAt>D ST PH 11.ADE5..PH I A. PA 131 *. S Mumbcr ol" Litis nocice; CP 5VS B i-'or iissistjincu you mciy us al 1 -B0O-c:!S-'',933 F VOU WRITE, ATTACH THli STUB AT THE END OF THIS NOTICE. WE-: ASSIGNKD YOU AM W-t^iOYKR I DF.mT K! CAT;ON MUMHICR Thank yon for apply iny for an iimploycr HlcnL) f i csi: ion HuiTibei" (EIH). Wo iir.si.9ned you EIN ' 'i5. This EIN will ickmuify you, your business accounur,, Lax ireturns, and documents, even if you hfiva no f-'inployeiis. Plc-ASf? k-jep uhis notice in your pertnanl-nu records. When Lili::g cay. documouls, p;iyiii'jn:,s, uvxl r-eiaued cot'respon.dence, is very import.ant: chat you use your EIN find compietiu name rmd address exactly as shov.ii abovo.-. Any variacion may cause a delay in processing, r'esulc ir. incorrect; informac ion in your account:, or even cause you co b assigned more than one EIK. if the in.format ion is not correct as shown above, pl»ase make the correction using the attached tear off stub and return it to us. Based on une information received from you or your representat.ive, you must: file the following forwis) by thedav.efr.) shown. Korm 10S5 01/33/201.5 IE you have questions about; the t'ormjs) or' the due datefs) shown, you can call, us at the phone number or write to us at: the address shown at the top of th.is not;ice. If you need help in deterni.i.ni.ucf your annual account imj peri.od (tax year), see Publ icat i.on 53H, Accounning Periods una Mcchochi. we assigned you a tax classification based on infonnation obtained from you or your representative. It is not a legal determ.ination of your tax classification, and is not binding on the IRS. Tf you want a legal determination of your tax classification, you may request a private l.etuer t.'uliug from the TRS under the guidelines in Revenue Procedure , I.R.5. \ {or supecseding Mev-jnuu Procedure for the year at issue). Mote-. Certain tax classification elections can be requested by filing Form 883^., Entity Classification Eloction. See Form 3832 and its instructions for additional infocmation. A limited liability company (hlx') may file i-'orm 8S32, EiiLiLy CixsuiCicuLioti Ejection, and elect to be classified as an association, taxable as a corporation. If the I..[,C is eligible to be treated as n corporation that meets certain tests and it will be electing S corpora;: ion status, it: must timely file Fonn 2553, Klt.-cv.ion by a SntaJ] Business Corporation. The I.hC will be treated as a corporation as of the effective date of the S corporation election, tund does uot need to file Form To obtain tax forms and publications, including those referenced in this notice, visit our Web site at If you do not have access to the Internet, call i-& (TTY/TDD 1 -BO0-B39-405S) o:: visit your local IRS office.
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