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 Merger (Surviving Entity is a Domestic Entity) filed pursuant to § 7-90-203.7 of the Colorado Revised Statutes (C.R.S.) 1. For each merging entity, its 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 Entity name or true name Form of entity Jurisdiction Street address _________________________ (Colorado Secretary of State ID number) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ (Street number and name) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________ Mailing address (leave blank if same as street address) ______________________________________________________ (Street number and name or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________. ________________________________________________ ID Number Entity name or true name Form of entity Jurisdiction _________________________ (Colorado Secretary of State ID number) ______________________________________________________ ______________________________________________________ ______________________________________________________ MERGE_DOM Page 1 of 4 Rev. 5/29/2007 American LegalNet, Inc. www.FormsWorkFlow.com Street address ______________________________________________________ (Street number and name) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________ Mailing address (leave blank if same as street address) ______________________________________________________ (Street number and name or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________. ________________________________________________ ID Number Entity name or true name Form of entity Jurisdiction Street address _________________________ (Colorado Secretary of State ID number) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ (Street number and name) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________ Mailing address (leave blank if same as street address) ______________________________________________________ (Street number and name or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________. (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 Entity name or true name MERGE_DOM _________________________ (Colorado Secretary of State ID number) ______________________________________________________ Page 2 of 4 Rev. 5/29/2007 American LegalNet, Inc. www.FormsWorkFlow.com Form of entity Jurisdiction Street address ______________________________________________________ Colorado ______________________________________________________ (Street number and name) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________ Mailing address (leave blank if same as street address) ______________________________________________________ (Street number and name or Post Office Box information) ______________________________________________________ __________________________ ____ ____________________ (City) (Province ­ if applicable) (State) (Country) (ZIP/Postal Code) _______________________ ______________. 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 d