Free c156ds953950c11329 - Massachusetts

D PC

The Commonwealth of Massachusetts
William Francis Galvin Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512

FORM MUST BE TYPED

(General Laws Chapter 156D, Section 9.53; 950 CMR 113.29)
(1) Exact name of corporation prior to conversion: ____________________________________________________________

Articles of Entity Conversion of a Domestic Business Corporation to a Domestic Other Entity

FORM MUST BE TYPED

(2) Registered office address: ____________________________________________________________________________________ (number, street, city or town, state, zip code) (3) New name after conversion, which shall satisfy the organic law of the surviving entity: ________________________________________________________________________________________________

(4) New type of entity: __________________________________________________________________________________

(5) The plan of entity conversion was duly approved by the shareholders, and where required, by each separate voting group in the manner required by G.L. Chapter 156D and the articles of organization.

(6) Attach any additional sheets containing all information required to be set forth in the public organic document of the surviving entity.

(7) The conversion of the corporation shall be effective at the time and on the date approved by the Division, unless a later effective date is specified in accordance with the organic law of the surviving entity: ____________________________________

Signed by: ___________________________________________________________________________________________ , (signature of authorized individual) (Please check appropriate box) ® Chairman of the board of directors, ® President, ® Other officer, ® Court-appointed fiduciary,

on this _________________________ day of_________________________________________ , _____________________ of

P.C.

c156ds953950c11329 07/19/05

COMMONWEALTH OF MASSACHUSETTS
Secretary of the Commonwealth One Ashburton Place, Boston, Massachusetts 02108-1512

William Francis Galvin

(General Laws Chapter 156D, Section 9.53; 950 CMR 113.29)
I hereby certify that upon examination of these articles of conversion, duly submitted to me, it appears that the provisions of the General Laws relative thereto have been complied with, and I hereby approve said articles; and the filing fee in the amount of $______ having been paid, said articles are deemed to have been filed with me this _____________ day of _____________, 20______ , at _______a.m./p.m. time Effective date: _________________________________________________ (must be within 90 days of date submitted)

Articles of Entity Conversion of a Domestic Business Corporation to a Domestic Other Entity

WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth Filing fee: Minimum $250

Examiner Name approval C M

TO BE FILLED IN BY CORPORATION
Contact Information: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Telephone: ___________________________________________________ Email: ______________________________________________________ Upon filing, a copy of this filing will be available at www.sec.state.ma.us/cor. If the document is rejected, a copy of the rejection sheet and rejected document will be available in the rejected queue.