UMC-3 11/03
New Jersey Division of Revenue
Certificate of Merger/Consolidation
(Non-Profit Corporations)
This form may be used to record the merger or consolidation of a corporation with or into another business entity or entities,
pursuant to NJSA 15A. Applicants must insure strict compliance with the requirements of State law and insure that all filing
requirements are met. This form is intended to simplify filing with the State Treasurer. Applicants are advised to seek out private
legal advice before submitting filings to the Treasurer's office.
1. Type of Filing (check one): __ Merger __ Consolidation
2. Name of Surviving Corporation:
3. Name(s)/Jurisdiction(s) of All Participating Corporations:
Identification # Assigned By
Name Jurisdiction Treasurer (if applicable)
4. Date Merger/Consolidation approved:
5. Voting: (all corporations involved; attach additional sheets if necessary)
Corp. Name
(check one) ___ Has ___ Does not Have Members Eligible to Vote.
If the corporation has any class of members entitled to vote as a class, specify the class and the number of votes for each class:
Members Voting For ______ Members Voting Against ______ Total number of Trustees at the meeting ______ ; OR
Plan of merger/consolidation was adopted by the unanimous written consent of the members without a meeting (check)____
If there are no voting members:
Trustees Voting For ______ Trustees Voting Against ______ Total number of Trustees at the meeting ______ ; OR
Plan of merger/consolidation was adopted by the unanimous written consent of the Trustees without a meeting (check) ____
Corp. Name
(check one) ___ Has ___ Does not Have Members Eligible to Vote.
If the corporation has any class of members entitled to vote as a class, specify the class and the number of votes for each class:
Members Voting For ______ Members Voting Against ______ Total number of Trustees at the meeting ______ ; OR
Plan of merger/consolidation was adopted by the unanimous written consent of the members without a meeting (check)____
If there are no voting members:
Trustees Voting For ______ Trustees Voting Against ______ Total number of Trustees at the meeting ______ ; OR
Plan of merger/consolidation was adopted by the unanimous written consent of the Trustees without a meeting (check) ____
6. Service of Process Address (For use if the surviving business entity is not authorized or registered by the State Treasurer):
The surviving business entity agrees that it may be served with process in this State in any action, suit or proceeding for the
enforcement of any obligation of a merging or consolidating domestic or foreign business entity. The Treasurer is hereby
appointed as agent to accept service of process in any such action, suit, or proceeding which shall be forwarded to the surviving
business entity at the Service of Process address stated above.
7. Effective Date (see inst.):
Signature Name Title Date
________________________________________ ________________________________ ______________________________ ______________
________________________________________ ________________________________ ______________________________ ______________
________________________________________ ________________________________ ______________________________ ______________
**Remember to attach the plan of merger or consolidation.
NJ Division of Revenue, PO Box 308, Trenton NJ 08646
