Form Smg - Statement Of Merger (Domestic Or Foreign Partnership)
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1
2C
K
OMMONWEALTH OF
ENTUCKY
A
L
G
, S
S
LISON
UNDERGAN
RIMES
ECRETARY OF
TATE
_________________________________________________________________________________________________________________________
Division of Business Filings
Statement of Merger
SMG
Business Filings
PO Box 718
(Domestic or Foreign Partnership)
Frankfort, KY 40602
(502) 564-3490
__________________________________________________________________________________________
Pursuant to KRS 14A and KRS 362, the undersigned applies to qualify and for that purpose submits the following
statements:
1. The following partnership(s) or limited partnership(s) were parties to a merger and have merged into the surviving
entity:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. The name of the surviving entity is:
_________________________________________________________________________________________________
3. The street address of the surviving entity’s chief executive office is
_________________________________________________________________________________________________
Street Address or Post Office Box Numbers
City
State
Zip Code
4. The street address of the partnership office in Kentucky (if applicable):
_________________________________________________________________________________________________
Street Address or Post Office Box Numbers
City
State
Zip Code
5. The surviving entity is: ____ a partnership or ____ a limited partnership
We declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct.
_________________________________________________________________________________________________
Signature of partner
Print Name
Date
_________________________________________________________________________________________________
Signature of partner
Print Name
Date
(01/12)
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