TERMINATION OF MERGER OR CONSOLIDATION
1. The name and jurisdiction of formation or organization of each of the constituent companies are:
NAME JURISDICTION OF FORMATION
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2. An agreement of merger or consolidation has been filed with the Secretary of the Nation but has not
become effective
OR
A certificate filed with the Secretary of the Nation in lieu thereof has been filed but has not become
effective.
3. At this time ___________________________________________________________________
wishes to terminate the Agreement of merger or consolidation/certificate of merger or consolidation
(circle one)
4. A copy of the termination of merger or consolidation shall be furnished upon request and without
cost, to any person holding an interest in any constituent entity which was to merge or consolidate.
IN WITNESS WHEREOF, the constituent corporation has caused this termination or merger or
consolidation to be executed by its President or Vice President and attested by its Secretary or Assistant
Secretary this _______ day of __________________, _______.
_________________________________
By its _______ President
_________________________________
Please Print Name
ATTEST:
_____________________________
By its ________ Secretary
_____________________________
Please Print Name