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Connect With Us. 1100 4th Street, SW, Washington, DC 20024 Provide the entity name of the domestic entity that will remain in existence after the merger is complete.All information in this section must be completed. Instructions: • Complete and include this form with your paper submission. Check and complete one of the following addresses. Submit either the Statement of. Entity (NRS 92A.200). Mergers are business agreements designed to combine two or more entities into a single surviving entity. This form can be filled out on your computer and then printed. Conversions. File Name, 2022 File Upload, Information.