Form Mllc-10 - Limited Liability Company Statement Of Merger
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3Filing Fee $150.00
LIMITED LIABILITY COMPANY
STATE OF MAINE
_____________________
STATEMENT OF MERGER
Deputy Secretary of State
(Relating to a LLC)
A True Copy When Attested By Signature
_____________________
Deputy Secretary of State
Pursuant to
31 MRSA
§1641, the undersigned survivor of the merger executes and delivers the following Statement of Merger:
FIRST:
Constituent Organizations that are Parties to the Merger:
Name
Form of Organization
Jurisdiction
Date of Organization
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Name, form, jurisdiction and date of organization of additional limited liability companies or other constituent
organizations are attached as Exhibit ____, and made a part hereof.
SECOND:
Surviving Organization:
Name of surviving organization: ___________________________________________________________________
Form of surviving organization: _____________________________________
Jurisdiction of governing statute: _____________________ Date of its organization: _________________________
Address of its principal office: ______________________________________________________________________
THIRD:
(Check only one box)
The surviving organization is created by this merger. The organizational document that creates this
surviving organization is attached; or
The surviving organization existed before the merger. (Check only one box below)
Amendments provided for in the plan of merger for the organizational document that created the
surviving organization that are in the public record are attached; or
The organizational documents remain unchanged.
Form No. MLLC-10 (1 of 3)
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