Form Gp-6 - Statement Of Merger
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1GP-6
DOCUMENT # ________________________________
State of California
Secretary of State
STATEMENT OF MERGER
(Corporations Code section 16915(a).)
A $30.00 filing fee must accompany this form.
IMPORTANT — Read all instructions before completing this form.
This Space For Filing Use Only
SURVIVING ENTITY INFORMATION
1.
NAME OF SURVIVING ENTITY
2.
TYPE OF ENTITY
3. CA SECRETARY OF STATE FILE NUMBER, IF ANY
4. JURISDICTION
5.
STREET ADDRESS OF CHIEF EXECUTIVE OFFICE OF SURVIVING ENTITY
CITY AND STATE
ZIP CODE
6.
STREET ADDRESS OF CALIFORNIA OFFICE OF SURVIVING ENTITY, IF ANY
CITY
STATE
ZIP CODE
CA
DISAPPEARING ENTITY INFORMATION
(If more than one entity is disappearing, attach additional pages with the required information.)
7.
NAME OF DISAPPEARING ENTITY
8.
TYPE OF ENTITY
9. CA SECRETARY OF STATE FILE NUMBER, IF ANY
10. JURISDICTION
ADDITIONAL INFORMATION
11. ADDITIONAL INFORMATION SET FORTH ON ATTACHED PAGES, IF ANY, IS INCORPORATED HEREIN BY THIS REFERENCE AND MADE PART OF
THIS STATEMENT.
EXECUTION
(If additional signature space is necessary, the signature(s) may be made on an attachment to this document. Any attachments to this
document are incorporated herein by this reference.)
12.
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT OF
MY OWN KNOWLEDGE. I DECLARE I AM THE PERSON WHO EXECUTED THIS INSTRUMENT, WHICH EXECUTION IS MY ACT AND DEED.
SIGNATURE OF AUTHORIZED PERSON FOR THE SURVIVING ENTITY
DATE
TYPE OR PRINT NAME AND TITLE OF AUTHORIZED PERSON
SIGNATURE OF AUTHORIZED PERSON FOR THE SURVIVING ENTITY
DATE
TYPE OR PRINT NAME AND TITLE OF AUTHORIZED PERSON
GP-6 (REV 09/2006)
APPROVED BY SECRETARY OF STATE
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