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i <br /> �ff <br /> i <br /> Entity name or true name General Shale Brick,Inc. <br /> I <br /> Form of entity Corporation <br /> Jurisdiction Delaware i <br /> i <br /> Street address 3211 N.Roan Street ! <br /> (Street number and name) <br /> Johnson City TN 37602 j <br /> (City) (State) (7JP/Postal Code) i <br /> USA I <br /> (Province-ifappltcable) (Country) j <br /> i <br /> Mailin address <br /> (leave blank if same as street address) (Street number and name or Post Office Box information) <br /> I <br /> I <br /> (City) (state) (71P/Postal Code) <br /> (Province-;rapplicable) (Country) <br /> 3. Each merging entity has been merged into the surviving foreign entity. <br /> 4.(lfthe following statement applies,adopt the statement by marking the box and stare the appropriate document number(s)) <br /> ❑ One or more of the merging entities is a registrant of a trademark described in a filed document in the <br /> records of the secretary of state and the document number of each filed document is <br /> Document number <br /> Document number ' <br /> Document number T <br /> i <br /> (t(the following statement applies,adopt the statement by marking the box and include an attachment) <br /> ❑ There are more than three trademarks and the document number of each additional trademark is <br /> stated in an attachment. <br /> i <br /> 5. (Mark the applicable box and complete the statement.Caution: Mark only one box.) <br /> ❑✓ The surviving foreign entity maintains a registered agent in this state. <br /> OR <br /> ❑ The surviving foreign entity does not maintain a registered agent in this state and service of process <br /> may be addressed to the entity and mailed to the principal address pursuant to section 7-90-704(2), <br /> C_R.S. <br /> OR <br /> ❑ The surviving foreign entity has not maintained a registered agent in this state and appoints a <br /> registered agent to accept service pursuant to section 7-90-204.5,C.R.S. The person appointed as <br /> registered agent has consented to being so appointed.. Such registered agent's name and address are <br /> •Name <br /> (if an-individual) <br /> (Last) (Pirsq (Middle) (Sago) <br /> ....MERGE. `'. Page 3of5 Rev.S/192007 <br /> t <br />