Free FBT-03 - Arkansas

Arkansas Secre t a ry of State
Charlie Daniels
State Capitol · Little Rock, Arkansas 72201-1094 501-682-3409 · www.sos.arkansas.gov

Business & Commercial Services, 250 Victory Building, 1401 W. Capitol, Little Rock

Merger of Foreign Business Trust
The undersigned, pursuant to Act 1366 of 1999, sets forth the following: 1 . The name and jurisdiction of each of the trusts or business entities which are to merge or consolidate are: Name Jurisdiction

2. Please state whether or not an agreement of merger or consolidation has been approved and executed by each of the business trusts or other business entities which are to merge or consolidate.

3. Name of the surviving or resulting business trust or other business entity:

4. Date upon which merger or consolidation is effective (must be no later than 90 days after filing)

5. Please state that the executed agreement of merger or consolidation is on file at the principal place of business of the surviving trust or other business entity and please state the physical address of that principal place of business.

6. A copy of the agreement of merger or consolidation must be furnished by the surviving trust or business entity, on request and without cost, to any beneficial owner of any business trust or any person holding an interest in any other business entity which is to merge or consolidate. 7. Please state that you agree that your trust or other business entity may be served with service of process in Arkansas in any action, suit or proceeding for the enforcement of the business trust merging or consolidating by irrevocably appointing the Arkansas Secretary of State as the agent to accept such service of process.

I understand that knowingly signing a false document with the intent to file with the Arkansas Secretary of State is a Class C misdemeanor and is punishable by a fine up to $100.00 and/or imprisonment up to 30 days.

Authorized Officer and Title (Type or Print)

Authorized Signature

$300.00 Filing Fee payable to Arkansas Secretary of State

FBT-03 Rev. 4/06