Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
________________________________________________
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
There are more than three merging entities and the ID number (if applicable), entity name or true
name, form of entity, jurisdiction under the law of which it is formed, and the principal address of
each additional merging entity is stated in an attachment.
2. For the surviving entity, its entity ID number (if applicable), entity name or true name, form of entity,
jurisdiction under the law of which it is formed, and principal address are
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
MERGE_DOM
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