Free Fillable Certificate of Merger Form - New York

New York State Department of State Division of Corporations, State Records and Uniform Commercial Code One Commerce Plaza, 99 Washington Avenue Albany, NY 12231 www.dos.state.ny.us

CERTIFICATE OF MERGER OF
(Insert Name of Domestic Entity)

AND
(Insert Name of Domestic Limited Liability Company)

INTO

(Insert Name of Domestic Limited Liability Company)

Under Section 1003 of the Limited Liability Company Law

FIRST: The name (and if the name has been changed, the name under which it was formed) and jurisdiction of formation or organization of each domestic limited liability company or other domestic business entity that is to merge is: SECOND: For each domestic limited liability company and domestic other business entity,

the date when its initial articles of organization or formation document was filed with Department of State is:

THIRD: The name of the surviving domestic limited liability company is: FOURTH: The agreement of merger has been approved and executed by each of the domestic FIFTH: The future effective date of the merger, which does not exceed 30 days from the date
of filing, is:

limited liability companies or domestic other business entities that is a party thereto.

SIXTH: The Secretary of State is designated as agent of the surviving limited liability

company upon whom process against it may be served. The address within or without this state to which the Secretary of State shall mail a copy of any process against the limited liability company served upon him or her is:

DOS-1372 (Rev. 5/08)

-1-

SEVENTH: The agreement of merger is on file at the following place of business of the
surviving domestic limited liability company:

limited liability company on request and without cost to any member of any domestic limited liability company or to any person holding an interest in any other business entity that is to merge pursuant to such agreement.

EIGHTH: A copy of the agreement of merger will be furnished by the surviving domestic

X

(Name of Domestic Entity) (Signature) (Type or print name) (Title of signer)

X

(Name of Domestic Limited Liability Company) (Signature) (Type or print name) (Title of signer)

DOS-1372 (Rev. 5/08)

-2-

CERTIFICATE OF MERGER OF
(Insert Name of Domestic Entity)

AND
(Insert Name of Domestic Limited Liability Company)

INTO
(Insert Name of Domestic Limited Liability Company)

Under Section 1003 of the Limited Liability Company Law

Filed by:

(Name)

(Mailing address)

(City, State and ZIP code)

NOTE: This form was prepared by the New York State Department of State for filing a certificate of merger with a domestic business entity into a domestic limited liability company survivor. The certificate must be signed on behalf of each entity. It does not contain all optional provisions under the law. You are not required to use this form. You may draft your own form or use forms available at legal supply stores. The Department of State recommends that legal documents be prepared under the guidance of an attorney. The certificate must be submitted with a $60 filing fee made payable to the Department of State.
(For office use only)

DOS-1372 (Rev. 5/08)

-3-