Statement Of Consolidation Form - Colorado Secretary Of State Page 2
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7Entity name or true name:
______________________________________________________
(Enter name exactly as it appears in the records of the secretary of state if applicable)
ID number
:
_____________________
(if applicable)
Principal office street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Principal office mailing address: ______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
(If there are more than three consolidating entities, mark this box
and include an attachment stating the entity name,
ID number, and the principal office address of each additional consolidating entity.)
2. Entity name of new entity:
______________________________________________________
ID number
:
_____________________
(if applicable)
Principal office street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Principal office mailing address: ______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
3. If the consolidating entity is a foreign entity not qualified to transact business in Colorado:
True name:
______________________________________________________
Principal office street address:
______________________________________________________
(Street name and number)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Principal office mailing address: ______________________________________________________
(if different from above)
(Street name and number or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
CONSOLID
Page 2 of 3
Rev. 6/16/2005
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