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Jurisdiction <br /> Street address <br /> (Street number and name) <br /> (City) (State) (ZIP/Postal Code) <br /> (Province-if applicable) (Country) <br /> Mailing address <br /> (leave blank if same as street address) (Street number and name or Post Office Box information) <br /> (City) (State) (ZIP/Postal Code) <br /> (Province-if applicable) (Country) <br /> ID Number <br /> (Colorado Secretary of State 1D number) <br /> Entity name or true name <br /> Form of entity <br /> Jurisdiction <br /> Street address <br /> (Street number and name) <br /> (City) (State) (ZIP/Postal Code) <br /> (Province-if applicable) (Country) <br /> Mailing address <br /> (leave blank if same as street address) (Street number and name or Post Office Bax information) <br /> (City) (State) (ZIP/Postal Code) <br /> (Province-(f applicable) (Country) <br /> (If the following statement applies,adopt the statement by marking the box and include an attachment.) <br /> 0 There are more than three merging entities and the ID number(if applicable),entity name or true <br /> name,form of entity,jurisdiction under the law of which it is formed,and the principal address of <br /> each additional merging entity is stated in an attachment. <br /> 2. For the surviving entity which is a foreign entity,its entity ID number(if applicable),entity name or true <br /> name,form of entity,jurisdiction under the law of which it is formed,and principal address are <br /> (Caution: The surviving entity cannot be an entity formed under the laws of Colorado.) <br /> ID Number 20171214623 <br /> (Colorado Secretary of State ID number) <br /> MERGE_FGN Page 2 Rev.5/29/2007 <br />