Free Kentucky Secretary of State - Kentucky

Kentucky Secretary of State TREY GRAYSON
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Division of Corporations BUSINESS FILINGS P.O. Box 718 Frankfort, KY 40602 (502) 564-2848 http://www.sos.ky.gov/

Statement of Merger

SMG

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1.

The following partnerships [and limited partnerships] 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 (address must be a street address, not a post office box)
_________________________________________________________________________________________________________

4.

The street address of the partnership office in Kentucky, if there is one:
_________________________________________________________________________________________________________ _________________________________________________________________________________________________________

5.

The surviving entity is: a partnership a limited partnership

I declare under penalty of perjury under the laws of the state of Kentucky that the foregoing is true and correct. Executed by two partners _____________________________ (Day/Month/Year)
_____________________________________________________ ______________________________________________________

(Signature)
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(Signature)
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(Type or Print Name)

(Type or Print Name)

Instructions: Submit this form with one (1) exact or conformed copy. The filing fee is $40.00. Please make check payable to the "Kentucky State Treasurer." All information must be completed or this document will not be accepted for filing.

SMG (07/2006)