Free $25.00 - Alaska

Department of Commerce, Community, and Economic Development Corporations, Business, and Professional Licensing CORPORATIONS SECTION PO Box 110808

Juneau AK 99811-0808-0808

APPLICATION FOR CERTIFICATE OF CONVERSION
Limited Liability Company
Pursuant to the provisions of Alaska Statutes 10.50.570, the undersigned hereby applies for a Certificate of Conversion to transact business as a Limited Liability Company in the State of Alaska. 1. Name of the entity immediately before the filing of the certificate of conversion to a limited liability company:

2. Name of the limited liability company as stated in its articles of organization:

3. State or country were the entity was originally formed:

4. Date and the jurisdiction where the other entity was first created, formed, incorporated or otherwise came into being: Date: Jurisdiction: 5. The future effective date to a limited liability company if the conversion is not to be effective on the date of filing of the certificate of conversion to a limited liability company:

Signature of Manager, Member or Attorney-in-Fact

Printed Name

Title

Date

If you have specific legal questions or concerns about this filing, you are strongly advised to consult an attorney or other professional to assist you. The Application for Certificate of Conversion must be filed in conjunction with the Articles of Organization for a domestic entity and $250.00. The application for a Certificate of Conversion for a foreign entity must be filed in conjunction with the Application for Registration of a Foreign Limited Liability Company and $350.00. Foreign entities already on record in Alaska must also file a certified copy of the conversion from its state of domicile and a certificate of compliance. Mail the completed filing and the filing fees (in U.S. dollars) to: State of Alaska Corporations Section PO Box 110808 Juneau, AK 99811 For additional information or forms please visit our web site at: www.corporations.alaska.gov

08-431 (Rev. 08/05) alh