FLORIDA DEPARTMENT OF STATE  
                               DIVISION OF CORPORATIONS 
 
Attached is a form for filing Articles of Merger pursuant to section 617.1105, Florida Statutes, 
when two or more not for profit corporations merge. This form is basic and may not meet all 
merger needs.  The advice of an attorney is recommended. 
 
Please complete only one Plan of Merger form or attach your own Plan of Merger. 
 
The document must be typed or printed and must be legible. 
 
Pursuant to section 617.0123, Florida Statutes, a delayed effective date may be specified but may 
              th
not be later than the 90  day after the date on which the document is filed. 
 
Filing Fee                    $35.00 for each merging and $35 for each surviving 
                              corporation (Includes a letter of acknowledgment) 
 
Certified Copy (optional)  $8.75 
 
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 Amendment Section at (850) 245-6050. 
 
INHS65 (4/15)

                                                                COVER LETTER 
 
TO: Amendment Section 
    Division of Corporations 
 
SUBJECT:                                                                                            
                                                               (Name of Surviving Corporation) 
 
The enclosed Articles of Merger and fee are submitted for filing. 
 
Please return all correspondence concerning this matter to following: 
 
              (Contact Person) 
 
                (Firm/Company) 
 
                     (Address) 
 
         (City/State and Zip Code) 
 
For further information concerning this matter, please call: 
 
                                                                  At (       )                                                      
                                    (Name of Contact Person)                                (Area Code & Daytime Telephone Number) 
 
 Certified copy (optional) $8.75 (Please send an additional copy of your document if a certified copy is requested) 
 
    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 
                                    

                                       ARTICLES OF MERGER 
                                         (Not for Profit Corporations) 
                                                                 
The following articles of merger are submitted in accordance with the Florida Not For Profit Corporation 
Act, pursuant to section 617.1105, Florida Statutes. 
 
First:  The name and jurisdiction of the surviving corporation:  
 
Name                                       Jurisdiction                Document Number 
                                                                       (If known/ applicable) 
 
Second:  The name and jurisdiction of each merging corporation: 
 
Name                                       Jurisdiction                Document Number 
                                                                       (If known/ applicable) 
 
Third:  The Plan of Merger is attached. 
 
Fourth:  The merger shall become effective on the date the Articles of Merger are filed with the Florida 
          Department of State 
 
OR       / /  (Enter a specific date.  NOTE:  An effective date cannot be prior to the date of filing or more than 
      90 days after merger file date). 
 
Note:  If the date inserted in this block does not meet the applicable statutory filing requirements, this date will not be listed as the 
document’s effective date on the Department of State’s records. 
 
                                       (Attach additional sheets if necessary) 
 

Fifth:  ADOPTION OF MERGER BY SURVIVING CORPORATION 
             (COMPLETE ONLY ONE SECTION) 
 
SECTION I 
The plan of merger was adopted by the members of the surviving corporation on ________________________.  
The number of votes cast for the merger was sufficient for approval and the vote for the plan was as follows: 
____________ FOR ___________AGAINST 
 
SECTION II   
(CHECK IF APPLICABLE)   The plan or merger was adopted by written consent of the members and 
executed in accordance with section 617.0701, Florida Statutes. 
 
SECTION III 
There are no members or members entitled to vote on the plan of merger. 
The plan of merger was adopted by the board of directors on ______________.  The number of directors in 
office was ______________.  The vote for the plan was as follows: _____________FOR ____________ 
AGAINST 
 
Sixth:  ADOPTION OF MERGER BY MERGING CORPORATION(s) 
              (COMPLETE ONLY ONE SECTION) 
 
SECTION I 
The plan of merger was adopted by the members of the merging corporation(s) on 
________________________.  The number of votes cast for the merger was sufficient for approval and the vote 
for the plan was as follows: ____________ FOR ___________AGAINST 
 
SECTION II   
(CHECK IF APPLICABLE)   The plan or merger was adopted by written consent of the members and 
executed in accordance with section 617.0701, Florida Statutes. 
 
SECTION III 
There are no members or members entitled to vote on the plan of merger. 
The plan of merger was adopted by the board of directors on ______________.  The number of directors in 
office was ______________.  The vote for the plan was as follows: _____________FOR ____________ 
AGAINST 
 

Seventh:  SIGNATURES FOR EACH CORPORATION  
 
Name of Corporation       Signature of the chairman/        Typed or Printed Name of Individual & Title 
                          vice chairman of the board     
                          or an officer.                                          
 

                                  PLAN OF MERGER 

The following plan of merger is submitted in compliance with section 617.1101, Florida Statutes and in accordance 
with the laws of any other applicable jurisdiction of incorporation. 

The name and jurisdiction of the surviving corporation: 

Name                                                    Jurisdiction 

The name and jurisdiction of each merging corporation: 

Name                                                    Jurisdiction 

The terms and conditions of the merger are as follows:  

A statement of any changes in the articles of incorporation of the surviving corporation to be effected by the 
merger is as follows: 

Other provisions relating to the merger are as follows: