Chartering a Public Library in New York State
S A M P L E
PETITION FOR CONSENT TO MERGER WITH NOT-FOR-PROFIT CORPORATION
NOTE: THIS IS A SAMPLE DOCUMENT ONLY. PLEASE FOLLOW THIS FORMAT AND THE INSTRUCTIONS IN PARENTHESES ( ) WHEN DRAFTING YOUR OWN PETITION. PLEASE BE SURE TO HAVE THE NOTARY PUBLIC INCLUDE A COMPLETE ACKNOWLEDGMENT OF THE SIGNATURES ON THE PETITION, INCLUDING AN ACKNOWLEDGMENT STATEMENT SUCH AS THAT ON PAGE 2 AND HIS/HER STAMP AND SIGNATURE. IF THE SIGNATURES ARE ACKNOWLEDGED SEPARATELY, EACH ACKNOWLEDGMENT MUST INCLUDE THE STATEMENT, STAMP AND SIGNATURE.
[This document in MS Word format 
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TO THE REGENTS OF THE UNIVERSITY OF THE STATE OF NEW YORK
We the undersigned, persons of not less than eighteen years of age, desiring to merge __________________, a New York education corporation, and _____________, a __________ not-for-profit corporation, under the _________ Law of ____________, do hereby apply to the Regents of the University of the State of New York (the "Regents") for consent to such merger pursuant to the provisions of Section 216-a of the Education Law of the State of New York (the "Education Law").
_______________ was granted (a provisional/an absolute) charter on _______ by the Regents in accordance with Sections 216 and 217 of the Education Law. The purposes for which _____________ was formed were to ___________ .
(Repeat for not-for-profit corporation.)
______________ and _______________ have entered into a plan of merger which has received (the unanimous consent of the trustees and directors of each corporation) or (consent of at least three-fourths of the boards of trustees and directors). The certificate of merger, agreement and plan to merge, and verified certificates of approval of the agreement to merge are annexed hereto as exhibits A, B and C.
IN WITNESS WHEREOF, we have made, signed, and acknowledged this application as of the ____ day of ___________, 20___.
Signature
Typed name/President
New York education corporation
Signature
Typed name/Secretary
Signature
Typed name/President
Not-for-profit corp.
Signature
Typed name/Secretary
STATE OF NEW YORK )
ss.:
COUNTY OF )
On this _____ day of ___________, 20___, before me personally came ___________ and _____________, _________ _____________, and _________, to me known to be the persons described in and who executed the foregoing application on behalf of _________________ and ______________, and they duly acknowledged to me that they executed the same for the purposes stated therein.
(Typed name and/or stamp and signature of notary public.)
VERIFIED CERTIFICATE OF APPROVAL
STATE OF NEW YORK )
ss.:
COUNTY OF )
I, ____________, President and I, ________, Secretary of _____________, an education corporation organized under the laws of the State of New York, do hereby certify that in accordance with Section 216-a of the Education Law of the State of New York and Section ___ of the _________ Laws of _________, the trustees of ________________have duly consented to and approved and adopted the following resolutions of the board of trustees:
RESOLVED, that the plan and agreement of merger of ______________ and _____________, attached hereto as Exhibit ____, is approved and adopted on the ____ day of ________, 20____.
RESOLVED, that ______________, the President of ___________ and ____________, Secretary of ____________, are authorized to execute all appropriate documents in connection with such plan of merger, to submit such a plan to the Regents of the University of the State of New York and to file articles of merger regarding the same with the Secretary of State of the (State or Commonwealth) of _________________.
I FURTHER CERTIFY that: either (a) this action was approved by (the entire or not less than three-quarters) of the board of trustees of ____________ at a meeting held on _______________ or (b) a list of the names and post office addresses of the trustees of ____________, the names of those trustees who received said resolutions and their responses is attached hereto and incorporated herein as Exhibit ____.
IN WITNESS WHEREOF, we have hereunto set our hands this _____ day of _________, 20____.
(Please include notary acknowledgment as on other documents.)