Office of the Minnesota Secretary of State Statement of Merger Minnesota Statutes, Chapter 323A Read the instructions before completing this form. Filing Fee: $155 for expedited service in-person, $135 if submitted by mail A person who files a statement pursuant to this section shall promptly send a copy of the statement to every non-filing partner and to any other person named as a partner in the statement. 1. List the names of all partnerships or limited partnerships that are merged into the surviving entity: (Required) NOTE: Attach additional sheets for partnerships that are merged into the surviving entity if necessary. 2. Provide the name of the surviving entity: (Required) 3. Provide the street address of the surviving entity's chief executive office: (Required) Street Address (A PO Box by itself in unacceptable) City State Zip 4. Provide the street address of the surviving entity's office located in Minnesota (if any): Street Address (A PO Box by itself in unacceptable) 5. Check One Box Only: (Required) City Yes Yes State Zip The surviving entity is a partnership: The surviving entity is a limited partnership: 6. I, the undersigned, certify that I am signing this document as the person whose signature is required, or as agent of the person(s) whose signature would be required who has authorized me to sign this document on his/her behalf, or in both capacities. I further certify that I have completed all required fields, and that the information in this document is true and correct and in compliance with the applicable chapter of Minnesota Statutes. I understand that by signing this document I am subject to the penalties of perjury as set forth in Section 609.48 as if I had signed this document under oath. Signature of at Least Two Partners or of the Agent Date If you are signing as the agent for additional parties and the parties are not named in this document, and the additional parties' signatures are required by law, please list your name in the box followed by "and as agent for (insert names of other parties)" American LegalNet, Inc. www.FormsWorkFlow.com Office of the Minnesota Secretary of State Statement of Merger Minnesota Statutes, Chapter 323A Email Address for Official Notices Enter an email address to which the Secretary of State can forward official notices required by law and other notices: Check here to have your email address excluded from requests for bulk data, to the extent allowed by Minnesota law. List a name and daytime phone number of a person who can be contacted about this form: Contact Name Phone Number StatementofmergerRev.7/15/2013 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS File your business document online by visiting our website at www.sos.state.mn.us. This form is intended merely as a guide for filing and is not intended to cover all situations. Retain the original signed copy of this document for your records and submit a legible photocopy for filing with the Office of the Secretary of State. A person who files a statement pursuant to this section shall promptly send a copy of the statement to every non-filing partner and to any other person named as a partner in the statement. 1. List the names of each partnership or limited partnership that is a party to the merger. Please provide an attachment if there is not enough room to complete this section. 2. List the name of the surviving entity into which the other partnerships or limited partnerships were merged. 3. List the complete street address of the surviving entity's chief executive office. 4. List the complete street address of the surviving entity's office address in Minnesota, if any. 5. List whether the surviving entity is a partnership or a limited partnership. Check ONE box only. 6. If this document is being filed on behalf of the partnership, it must be signed by at least two partners who are authorized to sign the registration or by an Authorized Agent (The signing party must indicate on the document that they are acting as the agent of the person(s) whose signature would be required and that they have been authorized to sign on behalf of that person(s).). Email Address for Official Notices. This email address may be used to send annual renewal reminders and other important notices that may require action or response. Check the box if you wish to have your email address excluded from requests for bulk data, to the extent allowed by Minnesota law. List a name and daytime telephone number of a person who can be contacted about this form. Filing Fee: $155 for expedited service in-person and online filings, $135 if submitted by mail Payable to the MN Secretary of State Please submit all items together and mail to the address below: FILE IN-PERSON OR MAIL TO: Minnesota Secretary of State - Business Services Retirement Systems of Minnesota Building 60 Empire Drive, Suite 100 St Paul, MN 55103 (Staffed 8 a.m. ­ 4 p.m., Monday - Friday, excluding holidays) Phone Lines: (9 a.m. - 4 p.m., M-F) Metro Area 651-296-2803; Greater MN 1-877-551-6767 All of the information on this form is public. Minnesota law requires certain information to be provided for this type of filing. If that information is not included, your document may be returned unfiled. This document can be made available in alternative formats, such as large print, Braille or audio tape, by calling (651)296-2803/voice. For a TTY/TTD (deaf and hard of hearing) communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651)296-2803. The Secretary of State's Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age, marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of service. American LegalNet, Inc. www.FormsWorkFlow.com