Form of entity
______________________________________________________
Jurisdiction
Colorado
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)
3. Each merging entity has been merged into the surviving entity.
4.
(If the following statement applies, adopt the statement by marking the box.)
The plan of merger provides for amendments to a constituent filed document of the surviving entity and
an appropriate statement of change or other document effecting the amendments will be delivered to the
Secretary of State for filing pursuant to Part 3 of Article 90 of Title 7, C.R.S.
5.
(If the following statement applies, adopt the statement by marking the box and state the appropriate document number(s).)
One or more of the merging entities is a registrant of a trademark described in a filed document in the
records of the secretary of state and the document number of each filed document is
Document number
_________________________
Document number
_________________________
Document number
_________________________
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
There are more than three trademarks and the document number of each additional trademark is
stated in an attachment.
6.
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains additional information as provided by law.
7.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant
legal consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document are ___________________________.
(mm/dd/yyyy hour:minute am/pm)
MERGE_DOM
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Rev. 5/29/2007
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