Statement Of Merger {DSCB 15-335}

PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORGANIZATIONS Return document by mail to: Statement of Merger Name Address City State Zip Code DSCB:15-335 (7/1/2015) Return document by email to: _________________________________ *335* 335 Read all instructions prior to completing. Fee: $70 plus $40 for each association that is a party to the merger The minimum amount to be submitted with this filing is $150 In compliance with the requirements of the applicable provisions of 15 Pa.C.S. § 335 (relating to Statement of merger), the undersigned, desiring to effect a merger, hereby states that: A. For the surviving association: 1. The name of the surviving association is: __________________________________________________________ 2. The jurisdiction of formation of the surviving association: _____________________________________________ 3. The type of association of the surviving association is (check only one): Business Corporation Nonprofit Corporation Limited Liability Company Limited Partnership Limited Liability (General) Partnership Limited Liability Limited Partnership Business Trust Professional Association Other _________________________________ American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-335­2 4. The surviving association is a (check only one box, provide address and follow instructions for attachments): Domestic (Pennsylvania) filing entity already in existence on Department of State records If applicable, attach to this Statement any amendment to its public organic record approved as part of the plan of merger. NEW domestic (Pennsylvania) filing entity (includes limited liability limited partnership) Attach to this Statement the public organic record of the new entity. Foreign filing association or foreign limited liability partnership already registered with the Department. If applicable, attach to this Statement any amendment to or transfer of its foreign registration approved as part of the plan of merger. Foreign filing association or foreign limited liability partnership simultaneously seeking registration with the Department of State Attach to this Statement a completed form DSCB:15-412 (Foreign Registration Statement) with applicable fee and attachments. Its current registered office address. Complete part (a) OR (b) ­ not both: (a) ______________________________________________________________________________________________ Number and street City State Zip County (b) c/o: ___________________________________________________________________________________________ Name of Commercial Registered Office Provider County NEW domestic (Pennsylvania) limited liability partnership or electing partnership Attach completed DSCB:15-8201 (Statement of Registration) or DSCB:15-8701A (Statement of Election) Domestic association that is not a domestic filing association Attach to this Statement tax clearance certificates. The address, including street and number, if any, of its principal office: __________________________________________________________________________________________________ Number and street City State Zip County Foreign association that is not, and will not, be registered with the Department of State Attach to this Statement tax clearance certificates. The address, including street and number, if any, of its registered or similar office, if any, required to be maintained by the law of its jurisdiction of formation; or if it is not required to maintain a registered or similar office, its principal office: __________________________________________________________________________________________________ Number and street City State Zip American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-335­3 B. For the merging association(s) that are not surviving the merger: 1. The name of the merging association is: ____________________________________________________________ 2. The jurisdiction of formation of the merging association: ______________________________________________ 3. The type of association is (check only one): Business Corporation Limited Partnership Nonprofit Corporation Limited Liability (General) Partnership Limited Liability Company Limited Liability Limited Partnership 4. Check and complete one of the following addresses. If the merging association is a domestic filing association, domestic limited liability partnership or registered foreign association, the current registered office address as on file with the Department of State. Complete part (a) OR (b) ­ not both: (a) _________________________________________________________________________________________________ Number and street City State Zip County Business Trust Professional Association Other ___________________ (b) c/o: ______________________________________________________________________________________________ Name of Commercial Registered Office Provider County If the merging association is a domestic association that is not a domestic filing association or limited liability partnership, the address, including street and number, if any, of its principal office: ____________________________________________________________________________________________________ Number and street City State Zip County If the merging association is a nonregistered foreign association, the address, including street and number, if any, of its registered or similar office, if any, required to be maintained by the law of its jurisdiction of formation; or if it is not required to maintain a registered or similar office, its principal office address: ____________________________________________________________________________________________________ Number and street City State Zip Use Statement of Merger ­ Addendum (DSCB:15-335AD) for additional merging parties that are not surviving the merger. American LegalNet, Inc. www.FormsWorkFlow.com DSCB:15-335­4 C. Effective date of statement of merger (check, and if appropriate complete, one of the following): This Statement of Merger shall be effective upon filing in the Department of State. This Statement of Merger shall be effective on: _________________________ at __________________. Date (MM/DD/YYYY) Hour (if any) D. Approval of merger by merging associations (check all applicable statement(s)): For domestic entities ­ The merger was approved in accordance with 15 Pa.C.S. Chapter 3, Subchapter C (relating to merger). For foreign associations ­ The merger was approved in accordance with the laws of the jurisdiction of formatio