FLORIDA DEPARTMENT OF STATE  
                         DIVISION OF CORPORATIONS 
 
Attached is a form to file a Certificate of Merger pursuant to section 620.8918, Florida 
Statutes.  This form is basic and may not meet all merger needs.  The advice of an 
attorney is recommended. 
 
Filing Fee:                  $25.00 for each party 
 
Certified Copy (optional):   $52.50  
 
Send one check in the total amount payable to the Florida Department of State. 
 
Please include a cover letter containing your telephone number, return address and 
certification requirements, or complete the attached cover letter. 
 
 Mailing Address:                    Street Address: 
 Amendment Section                   Amendment Section 
 Division of Corporations            Division of Corporations 
 P.O. Box 6327                       The Centre of Tallahassee 
 Tallahassee, FL 32314               2415 N. Monroe Street, Suite 810 
                                     Tallahassee, FL 32303 
 
For further information, you may contact the Registration Section at (850) 245-6050. 
 
CR2E115 (4/13) 

                                                           COVER LETTER 
                                                               
TO: Amendment Section 
    Division of Corporations 
 
SUBJECT:                                                                                                           
                                                           Name of Surviving Party 
                                                               
The enclosed Certificate of Merger and fee(s) are submitted for filing. 
 
Please return all correspondence concerning this matter to: 
 
                                             Contact Person 
 
                                             Firm/Company 
 
                                                   Address 
                                                               
                                     City, State and Zip Code 
 
         E-mail address: (to be used for future annual report notification) 
 
For further information concerning this matter, please call: 
 
                                                              at (                 )                               
              Name of Contact Person                                       Area Code and Daytime Telephone Number 
 
☐ Certified copy (optional) $52.50 
 
    Mailing Address:                                               Street Address: 
    Amendment Section                                              Amendment Section 
    Division of Corporations                                       Division of Corporations 
    P.O. Box 6327                                                  The Centre of Tallahassee 
    Tallahassee, FL 32314                                          2415 N. Monroe Street, Suite 810 
                                                                   Tallahassee, FL 32303 
 

                              Certificate of Merger 
                               For 
                              Florida Partnership 

The following Certificate of Merger is submitted in accordance with s. 620.8918, Florida 
Statutes. 

FIRST:  The exact name, form/entity type, and jurisdiction for each merging party are as 
follows: 

Name                                   Jurisdiction  Form/Entity Type 

SECOND:  The exact name, form/entity type, and jurisdiction of the surviving party are 
as follows: 

Name                                   Jurisdiction  Form/Entity Type 

THIRD:  The date the merger is effective under the governing laws of the 

surviving party is:                                  . 

(NOTE:  If survivor is a Florida partnership, effective date cannot be prior to nor more 
than 90 days after the date this document is filed by the Florida Department of State.  If 
survivor is not a Florida partnership, effective date shall be as provided in the governing 
law of the surviving party.) 

FOURTH:  The merger was approved by each party as required by its governing law. 

                               1 of 3 

FIFTH:  If the surviving party is a foreign organization not qualified to transact business 
in this state, the street address and mailing address of an office which the Florida 
Department of State may use for the purposes of s. 620.8919(2), F.S., are as follows: 

Street address:  

Mailing address: 

SIXTH:  Other provisions, if any, relating to the merger: 

                 2 of 3 

SEVENTH:  Signature(s) for Each Party: 
 
(Merger must be signed by all general partners of each partnership and by the authorized 
representative of each other party.) 
 
                                                       Typed or Printed 
Name of Entity/Organization:           Signature(s):   Name of Individual: 
 
Fees:  Filing Fees:  $25.00 Per Party 
     Certified Copy: $52.50 (Optional) 
     Certificate of Status:    $8.75 (Optional) 
 
                                       3 of 3