Filing Fee $145.00
DOMESTIC BUSINESS CORPORATION STATE OF MAINE
ARTICLES OF ENTITY CONVERSION
_____________________ Deputy Secretary of State A True Copy When Attested By Signature
______________________________________
(Name of Corporation Prior to Conversion)
_____________________ Deputy Secretary of State
Pursuant to 13-C MRSA §955.1, the undersigned corporation executes and delivers the following Articles of Entity Conversion: FIRST: The name of the corporation is changed as follows (the name must satisfy the organic law of the surviving entity): _______________________________________________________________________________________________ SECOND: THIRD: FOURTH: The type of unincorporated entity that the surviving entity will be: ________________________________________. The plan of entity conversion was duly approved by the shareholders in the manner required by this Act and the corporation's articles of incorporation. If the surviving entity is a filing entity, attached is Exhibit ________ which contains all the provisions required to be set forth in its public organic document with any other desired provisions that are permitted. For a Domestic Limited Liability Company, attach form MLLC-6-1. For a Domestic Limited Partnership, attach form MLPA-6-1. FIFTH: The effective date of the articles of entity conversion (if other than the date of filing of the articles of entity conversion) is _______________________________.
DATED _________________________
*By __________________________________________________
(signature of an officer or other duly authorized representative)
__________________________________________________
(type or print name and capacity)
*This document MUST be signed by an officer or other duly authorized representative. (13-C MRSA §955.1) Please remit your payment made payable to the Maine Secretary of State. SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE, 101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101 FORM NO. MBCA-21 (1 of 1) Rev. 8/1/2004 TEL. (207) 624-7752