"Statement of Merger (Surviving Entity Is a Domestic Entity)" - Colorado

Statement of Merger (Surviving Entity Is a Domestic Entity) is a legal document that was released by the Colorado Secretary of State - a government authority operating within Colorado.

Form Details:

  • Released on May 29, 2007;
  • The latest edition currently provided by the Colorado Secretary of State;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Colorado Secretary of State.

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Download "Statement of Merger (Surviving Entity Is a Domestic Entity)" - Colorado

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Document processing fee
If document is filed on paper
$150.00
If document is filed electronically
Currently Not Available
Fees & forms/cover sheets are
subject to change.
To file electronically, access instructions
for this form/cover sheet and other
information or print copies of filed
documents, visit www.sos.state.co.us
and select Business.
Paper documents must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Statement of Merger
(Surviving Entity is a Domestic Entity)
filed pursuant to
§ 7-90-203.7
of the Colorado Revised Statutes (C.R.S.)
1. For each merging entity, its ID number (if applicable), entity name or true name, form of entity, jurisdiction
under the law of which it is formed, and principal address are
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
________________________________________________
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
MERGE_DOM
Page 1 of 4
Rev. 5/29/2007
Document processing fee
If document is filed on paper
$150.00
If document is filed electronically
Currently Not Available
Fees & forms/cover sheets are
subject to change.
To file electronically, access instructions
for this form/cover sheet and other
information or print copies of filed
documents, visit www.sos.state.co.us
and select Business.
Paper documents must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Statement of Merger
(Surviving Entity is a Domestic Entity)
filed pursuant to
§ 7-90-203.7
of the Colorado Revised Statutes (C.R.S.)
1. For each merging entity, its ID number (if applicable), entity name or true name, form of entity, jurisdiction
under the law of which it is formed, and principal address are
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
________________________________________________
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
MERGE_DOM
Page 1 of 4
Rev. 5/29/2007
Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
________________________________________________
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
There are more than three merging entities and the ID number (if applicable), entity name or true
name, form of entity, jurisdiction under the law of which it is formed, and the principal address of
each additional merging entity is stated in an attachment.
2. For the surviving entity, its entity ID number (if applicable), entity name or true name, form of entity,
jurisdiction under the law of which it is formed, and principal address are
ID Number
_________________________
(Colorado Secretary of State ID number)
Entity name or true name
______________________________________________________
MERGE_DOM
Page 2 of 4
Rev. 5/29/2007
Form of entity
______________________________________________________
Jurisdiction
Colorado
Street
address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing
address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
3. Each merging entity has been merged into the surviving entity.
4.
(If the following statement applies, adopt the statement by marking the box.)
The plan of merger provides for amendments to a constituent filed document of the surviving entity and
an appropriate statement of change or other document effecting the amendments will be delivered to the
Secretary of State for filing pursuant to Part 3 of Article 90 of Title 7, C.R.S.
5.
(If the following statement applies, adopt the statement by marking the box and state the appropriate document number(s).)
One or more of the merging entities is a registrant of a trademark described in a filed document in the
records of the secretary of state and the document number of each filed document is
Document number
_________________________
Document number
_________________________
Document number
_________________________
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
There are more than three trademarks and the document number of each additional trademark is
stated in an attachment.
6.
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains additional information as provided by law.
7.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant
legal consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document are ___________________________.
(mm/dd/yyyy hour:minute am/pm)
MERGE_DOM
Page 3 of 4
Rev. 5/29/2007
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is
such individual's act and deed, or that such individual in good faith believes such document is the act and deed
of the person on whose behalf such individual is causing such document to be delivered for filing, taken in
conformity with the requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent
documents and the organic statutes, and that such individual in good faith believes the facts stated in such
document are true and such document complies with the requirements of that Part, the constituent documents,
and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of
State, whether or not such individual is identified in this document as one who has caused it to be delivered.
8. The true name and mailing address of the individual causing this document to be delivered for filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____
____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains the true name and mailing address of one or more additional individuals
causing the document to be delivered for filing.
Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice,
and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy
minimum legal requirements as of its revision date, compliance with applicable law, as the same may be
amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should
be addressed to the user’s legal, business or tax advisor(s).
MERGE_DOM
Page 4 of 4
Rev. 5/29/2007
Business Information Survey (Optional)
For office use only
Submit with your form if you want to add, change, or remove survey information
Survey information can be added, changed, or removed when you file a form with our
office. The information on this survey is associated with the entity’s record- it does not
become a part of the document that you file with us.
This survey is voluntary. Any information that you enter will be available to the public. The
information is being gathered as required by law- see House Bill 13-1167 for information.
Entity information
ID number
Entity name
Choose one:
1. Remove all survey information from this entity’s record.
2. Add or update the survey information on this entity’s record as follows:
a) Gender
Male
Female
Choose not to answer / Remove this information
b) Veteran?
Yes
No
Choose not to answer / Remove this information
c) Person with a disability?
Yes
No
Choose not to answer / Remove this information
d) Race
African American
Latino
Anglo
Native American
Asian
Other
Choose not to answer / Remove this information
SurveyInfo
Page 1 of 2
Rev. 12/11/2013