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 Foreign 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 limited liability company or other 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: For each foreign limited liability company and foreign other business entity, the

jurisdiction and date of filing of its original articles of organization or formation document and the date when its application for authority was filed by the Department of State is (if no such application has been filed, a statement to such effect):

limited liability companies or other business entities that is to merge.

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

DOS-1371 (Rev. 5/08)

-1-

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:

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

EIGHTH: The merger is permitted by the jurisdiction of organization or incorporation for each foreign limited liability company or foreign other business entity and is in compliance therewith. NINTH: 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.

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

X

(Name of Foreign 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-1371 (Rev. 5/08)

-2-

CERTIFICATE OF MERGER OF
(Insert Name of Foreign 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 foreign limited liability company survivor. 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-1371 (Rev. 5/08)

-3-