Free Certificate of Conversion (to LLC under 48-21-111) - Tennessee

For Office Use Only

(Domestic For-Profit Corporation into LLC
under TCA §48-21-111) Corporate Filings 312 Eighth Avenue North 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 (For use on or after 7/1/2006)

CERTIFICATE OF CONVERSION

Pursuant to the provisions of §48-21-111 of the Tennessee Business Corporation Act and §48-249703 of the Tennessee Revised Limited Liability Company Act, the undersigned hereby submits this certificate of conversion:
1. The name and principal business address of the converting domestic corporation is:

2. The converting corporation was formed in Tennessee, its date of formation is
(if known) is:

(month/day/year), and its SOS control number

3. The converting corporation is being converted to a domestic limited liability

company, and the name of the domestic limited liability company as set forth in its article of organization is:



4. The plan of conversion is attached to this certificate of conversion and is
incorporated herein by reference.

5. The terms and conditions of the conversion have been approved by the unanimous vote of the shareholders; all required approvals of the conversion have been obtained by the converting corporation. 6. The number of members of the limited liability company at the date of conversion is . 7. If the conversion is not to be effective upon the filing of the certificate of conversion and articles of organization, then the future effective date and time of the conversion is: Date: , Time:

Signature Date











Signature

Signer's Capacity (if other than individual capacity)

Name (printed or typed)
RDA 2458

SS-4498 (Rev. 05/06)

Filing Fee $20