Fillable State of Utah DEPARTMENT OF COMMERCE Division of (Utah Division of Corporations & Commercial Code)

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State of Utah DEPARTMENT OF COMMERCE Division of (Utah Division of Corporations & Commercial Code)

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Non-Refundable Processing Fee: $37.00
Pursuant to UCA 48-3A-1025, the undersigned parties of the merger execute and deliver the following Statement of Merger:
First: Non-surviving Entities that are Parties to the Merger:
Name of Business Entity:_______________________________________________________________________________
Entity Type:____________________________ Jurisdiction:______________________
Name of Business Entity:_______________________________________________________________________________
Entity Type:____________________________ Jurisdiction:______________________
Name of Business Entity:_______________________________________________________________________________
Entity Type:____________________________ Jurisdiction:______________________
Name of Business Entity:_______________________________________________________________________________
Entity Type:____________________________ Jurisdiction:______________________
Name of Business Entity:_______________________________________________________________________________
Entity Type:____________________________ Jurisdiction:______________________
Additional Business Entities that are Parties to the Merger have been named in an attached Exhibit and made a part hereof.
Second: Surviving Entity
Name of Business Entity:_______________________________________________________________________________
Entity Type:____________________________ Jurisdiction:______________________
Third: Approval Statement
This merger was approved by each domestic merging entity (if any) in accordance with Sections 48-3a-1021 through 48-3a-
1026 and by each foreign merging entity (if any) in accordance with the law of its jurisdiction of formation.
Fourth: Surviving Entity Creation/Existence
The surviving entity is created by this Statement of Merger. The formation document that creates the surviving
entity is attached.
The surviving entity is a Non-registered Foreign Entity.
The surviving entity existed before this Statement of Merger. (select only one option below)
Amendments provided in the plan of merger for the formation document that created the surviving
entity that are in the public record are attached.
The formation documents remain unchanged.
State of Utah
DEPARTMENT OF COMMERCE
Division of Organizations & Commercial Code
Limited Liability Company Statement of Merger
Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you
may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity.
This form cannot be hand written.
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Fifth: Mailing Address for Service of Process pursuant to Subsections 48-3a-1026(5) and 16-17-301(2)
(for Non-registered Foreign Surviving Entities ONLY)
Address: _____________________________________________________________________________________________
City: ________________________________________________ State: _______________________ Zip: _____________
Sixth: Required Signatures
Surviving Entity:_______________________________________________________________________________
Name:____________________________ Title:______________________
Signature:____________________________ Date:______________________
Non-surviving Entity:_______________________________________________________________________________
Name:____________________________ Title:______________________
Signature:____________________________ Date:______________________
Non-surviving Entity:_______________________________________________________________________________
Name:____________________________ Title:______________________
Signature:____________________________ Date:______________________
Non-surviving Entity:_______________________________________________________________________________
Name:____________________________ Title:______________________
Signature:____________________________ Date:______________________
Non-surviving Entity:_______________________________________________________________________________
Name:____________________________ Title:______________________
Signature:____________________________ Date:______________________
Non-surviving Entity:_______________________________________________________________________________
Name:____________________________ Title:______________________
Signature:____________________________ Date:______________________
Include complete signatures for any additional Business Entities that have been named in an attached Exhibit.
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Division's Website:
www.corporations.utah.gov
www.corporations.utah.gov/contactus.html
03/16
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State of Utah DEPARTMENT OF COMMERCE Division of (Utah Division of Corporations & Commercial Code)

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Completed 29 July 2020

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