COMMONWEALTH OF KENTUCKY ALISON LUNDERGAN GRIMES, SECRETARY OF STATE _________________________________________________________________________________________________________________________ Division of Business Filings Business Filings PO Box 718 Frankfort, KY 40602 (502) 564-3490 www.sos.ky.gov Statement of Merger (Domestic or Foreign Partnership) SMG __________________________________________________________________________________________ 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) American LegalNet, Inc. www.FormsWorkFlow.com FILING INSTRUCTIONS STATEMENT OF MERGER NAME State the exact name of the partnerships (and limited partnerships) that are parties to the merger. SURVIVOR List the name of the surviving entity. WHO MAY SIGN The document must be signed by two general partners as authorized by KRS 362. PRINCIPAL OFFICE ADDRESS The principal office is the office (in or out of this state) so designated in writing with the Office of the Secretary of State where the principal designated office of the business entity is located. This address is where all correspondence from the Office of the Secretary of State (See Document Delivery) will be submitted. ADDRESSES List the address of the surviving entity; it must be a street location. If the surviving entity maintains an office in Kentucky, please list the address. WHO MUST SIGN The statement of merger shall be signed by two partners. NUMBER OF COPIES If filing via mail or in person, one exact or conformed copy of the document with the filing fee must be submitted to the address below. To make a copy of the filing for delivery to the local county clerk's office, visit www.sos.ky.gov and print a copy from the organization search tool. DOCUMENT DELIVERY A file stamped postcard will be sent to the principal office address. If the applicant wishes for the document to be sent to an alternate address other than the principal office, a request must be submitted in writing affirming that request. Alternate address requests must be submitted with each document filed with the Office of the Secretary of State. FILING FEE The filing fee is $40.00. Checks should be made payable to the "Kentucky State Treasurer." MAILING ADDRESS Alison Lundergan Grimes Secretary of State P. O. Box 718 Frankfort, KY 40602-0718 OFFICE LOCATION Room 154, Capitol Building 700 Capital Avenue Frankfort, KY 40601 Hours of Operation: 8:00 AM-4:30 PM ET CONTACT INFORMATION If you have any questions or need additional forms, please feel free to visit our website at www.sos.ky.gov or call (502) 564-3490. American LegalNet, Inc. www.FormsWorkFlow.com