Charitable Organization Report Of Merger Form

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Charities Program
PO Box 40234
Olympia, WA 98504-0234
Phone: 360-725-0378
Web Address:
Charitable Organization REPORT OF MERGER
NO FEE
Expedited Service
$50
(Optional)
 Need to merge a Nonprofit Corporation? Please contact the Corporations Div. at
corps@sos.wa.gov
or (360) 725-0377.
EFFECTIVE DATE OF MERGER: ____/____/_____
(mm/dd/yyyy)
SURVIVING ORGANIZATION INFORMATION
(Section 1)
Name of Surviving Organization _____________________________________________________________________
Did the organization’s name change as a result of the merger? If so, provide its former name below
_____________________________________________________________________________________________________________________________________
Registration Number of Surviving Organization
_____________
(1-5 digits)
Need your registration number? Search
Federal EIN/Tax ID # of Surviving Organization
__ __ - __ __ __ __ __ __ __
(Nine digits
)
WA State Unified Business Identifier (UBI) of Surviving Organization
__ __ __-__ __ __-__ __ __
(Nine digits)
Accounting Year of Surviving Organization:
Begin Date ____/____/_____ End Date ____/____/_____
(mm/dd/yyyy)
(mm/dd/yyyy)
Contact Information for Surviving Organization:
Phone (
) _____________________________
Mailing Address ___________________________________________________________________________________
City __________________________________________ State _____________ Zip Code _______________________
Email ___________________________________ Website _________________________________________________
NON-SURVIVING ORGANIZATION INFORMATION
(Section 2)
Name of Non-Surviving Organization ________________________________________________________________
Registration Number of Non-Surviving Organization
_____________
(1-5 digits)
Need your registration number? Search
Federal EIN/Tax ID # of Non-Surviving Organization
__ __ - __ __ __ __ __ __ __
(Nine digits
)
WA State Unified Business Identifier (UBI) of Non-Surviving Organization
__ __ __-__ __ __-__ __ __
(Nine digits)
Mailing Address of Non-Surviving Organization: ________________________________________________________
City __________________________________________ State _____________ Zip Code _______________________
Provide the above information for each non-surviving organization merged. If necessary, attach an additional sheet.
Page 1
Charitable Organization Merger
Washington Secretary of State
Revised 10/2013

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