INSTRUCTIONS: 1. Use 8275224 x 11224 white paper for attachments. 2. Please TYPE or PRINT in INK. 3. Please visit our office on the web at www.sos.IN.gov 4. Make check or money order payable to the Secretary of State. 5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204. REQUIREMENTS: Applicants must submit a certificate of existence or certificate of conversion issued by the proper authority. NOTE: This form may be used by a registered foreign entity that has merged into a non registered foreign entity or converts to a foreign entity required to register with the Secretary of State to do business in Indiana. NOTE: Following the completion of the merger, all assumed names of the non-surviving entity will be cancelled and available for use. If the surviving entity wishes to operate under any of the assumed names owned by the non-surviving entity, the surviving entity must file a Certificate of Assumed Business Name (State Form 30353) for each assumed name along with the Notice of Merger. Failure to do so may result in the assumed name being unavailable for use, as assumed names must now be distinguishable upon the record of the Secretary of State. (SOS use only) (If different from above 226 SOS use only) American LegalNet, Inc. www.FormsWorkFlow.com (select one) (Complete this section if you selected 223Merger224 in Article I.) Please list any Non-Surviving Foreign Entities (if any) in this merger. Please only name non-surviving entities that are registered with the Indiana Secretary of State's office. (month, day, year) (month, day, year) (Complete this section if you selected 223Conversion224 in Article I.) For LLC only: American LegalNet, Inc. www.FormsWorkFlow.com To be completed by the entity if different than the information for the foreign entity before the merger or conversion. Required under Indiana Code 23-0.5-4-3(b) To determine if your Registered Agent is a Commercial Registered Agent (CRA), go to INBIZ.in.gov. Provide either commercial registered agent or noncommercial registered agent information below. (Do not provide address.) (number and street) (A P.O. Box is not acceptable unless accompanied by a Rural Route number.) American LegalNet, Inc. www.FormsWorkFlow.com