Statement Of Merger (LLC)

State of Utah DEPARTMENT OF COMMERCE Division of Organizations & Commercial Code Limited Liability Company Statement of Merger Non-Refundable Processing Fee: $37.00 Pursuant to UCA 48-3A-1025, the undersigned parties of the merger execute and deliver the following Statement of Merger: First: Non-surviving Entities that are Parties to the Merger: Name of Business Entity:_______________________________________________________________________________ Entity Type:____________________________ Jurisdiction:______________________ Name of Business Entity:_______________________________________________________________________________ Entity Type:____________________________ Jurisdiction:______________________ Name of Business Entity:_______________________________________________________________________________ Entity Type:____________________________ Jurisdiction:______________________ Name of Business Entity:_______________________________________________________________________________ Entity Type:____________________________ Jurisdiction:______________________ Name of Business Entity:_______________________________________________________________________________ Entity Type:____________________________ Jurisdiction:______________________ Additional Business Entities that are Parties to the Merger have been named in an attached Exhibit and made a part hereof. Second: Surviving Entity Name of Business Entity:_______________________________________________________________________________ Entity Type:____________________________ Third: Approval Statement This merger was approved by each domestic merging entity (if any) in accordance with Sections 48-3a-1021 through 48-3a1026 and by each foreign merging entity (if any) in accordance with the law of its jurisdiction of formation. Fourth: Surviving Entity Creation/Existence The surviving entity is created by this Statement of Merger. The formation document that creates the surviving entity is attached. The surviving entity is a Non-registered Foreign Entity. The surviving entity existed before this Statement of Merger. (select only one option below) Amendments provided in the plan of merger for the formation document that created the surviving entity that are in the public record are attached. The formation documents remain unchanged. Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. American LegalNet, Inc. www.FormsWorkFlow.com Jurisdiction:______________________ Fifth: Mailing Address for Service of Process pursuant to Subsections 48-3a-1026(5) and 16-17-301(2) (for Non-registered Foreign Surviving Entities ONLY) Address: _____________________________________________________________________________________________ City: ________________________________________________ State: _______________________ Zip: _____________ Sixth: Required Signatures Surviving Entity:_______________________________________________________________________________ Name:____________________________ Title:______________________ Date:______________________ Signature:____________________________ Non-surviving Entity:_______________________________________________________________________________ Name:____________________________ Title:______________________ Date:______________________ Signature:____________________________ Non-surviving Entity:_______________________________________________________________________________ Name:____________________________ Title:______________________ Date:______________________ Signature:____________________________ Non-surviving Entity:_______________________________________________________________________________ Name:____________________________ Title:______________________ Date:______________________ Signature:____________________________ Non-surviving Entity:_______________________________________________________________________________ Name:____________________________ Title:______________________ Date:______________________ Signature:____________________________ Non-surviving Entity:_______________________________________________________________________________ Name:____________________________ Title:______________________ Date:______________________ Signature:____________________________ Include complete signatures for any additional Business Entities that have been named in an attached Exhibit. American LegalNet, Inc. www.FormsWorkFlow.com