Document processing fee If document is filed on paper $150.00 If document is filed electronically Currently Not Available Fees & forms/cover sheets are subject to change. To file electronically, access instructions for this form/cover sheet and other information or print copies of filed documents, visit www.sos.state.co.us and select Business. Paper documents must be typewritten or machine printed. ABOVE SPACE FOR OFFICE USE ONLY Statement of Consolidation filed pursuant to §7-90-301, et seq. and §7-56-605 Colorado Revised Statutes (C.R.S.) 1. Entity name or true name of consolidating entity: ID number (if applicable): Principal office street address: ______________________________________________________ (Enter name exactly as it appears in the records of the secretary of state if applicable) _____________________ ______________________________________________________ (Street name and number) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ Principal office mailing address: ______________________________________________________ (if different from above) (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ Entity name or true name: ID number (if applicable): Principal office street address: ______________________________________________________ (Enter name exactly as it appears in the records of the secretary of state if applicable) _____________________ ______________________________________________________ (Street name and number) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ Principal office mailing address: ______________________________________________________ (if different from above) (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ CONSOLID Page 1 of 3 Rev. 6/16/2005 American LegalNet, Inc. www.FormsWorkFlow.com Entity name or true name: ID number (if applicable): Principal office street address: ______________________________________________________ (Enter name exactly as it appears in the records of the secretary of state if applicable) _____________________ ______________________________________________________ (Street name and number) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ Principal office mailing address: ______________________________________________________ (if different from above) (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ (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) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ Principal office mailing address: ______________________________________________________ (if different from above) (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ 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) (Province ­ if applicable) (State) (Country ­ if not US) (Postal/Zip Code) _______________________ ______________ Principal office mailing address: ______________________________________________________ (if different from above) (Street name and number or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) CONSOLID Page 2 of 3 (State) (Postal/Zip Code) Rev. 6/16/2005 American LegalNet, Inc. www.FormsWorkFlow.com _______________________ ______________ (Province ­ if applicable) (Country ­ if not US) 4. If one or more of the consolidating entities is a registrant of a trademark described in a filed document in the and state below the document number of each such filed records of the secretary of state, mark this box document. Document number: Document number: (If more than two trademarks, mark this box _____________________ _____________________ and include an attachment stating the additional document numbers.) 5. Additional information may be included. If applicable, mark this box stating the additional information. 6. (Optional) Delayed effective date: Notice: ______________________ (mm/dd/yyyy) and include an attachment Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or acknowledgment of each individual causing such delivery, under penalties of perjury, that the document is the individual's act and deed, or