Statement of Conversion

281 STATEMENT OF CONVERSION Pursuant to § 30­22­405, Idaho Code Filing fee: $30 typed, $50 not typed Complete and submit the form in duplicate. Note: Conversion documents are complex. Please seek appropriate legal and/or financial advice before making this important business decision. 1. CONVERTING ENTITY: Name: Jurisdiction: Type: (Corporation, Limited Liability Company, Limited Partnership, etc...) This is a domestic entity, and this plan of conversion was approved in accordance with § 30­22­403, Idaho Code. This is a foreign entity, and this plan of conversion was approved in accordance with the law of its jurisdication of formation. 2. CONVERTED ENTITY: Name: Jurisdiction: Type: (Corporation, Limited Liability Company, Limited Partnership, etc...) a. If this is a domestic entity or domestic limited liability partnership, please attach a copy of the entity's public organic record, or statement of qualification. b. If this is a foreign entity please designate a registered agent in the space provided: (Registered Agent Name) (Address) 3. EFFECTIVE DATE OF CONVERSION: Effective upon filing On future date: (Enter date ­ not more than 90 days in the future) Secretary of State use only Printed Name: Capacity: Signature: Revised 08/2015 American LegalNet, Inc. www.FormsWorkFlow.com Title 30, Chapter 22, Part 4, Idaho Code 30-22-405. STATEMENT OF CONVERSION -- EFFECTIVE DATE OF CONVERSION. (a) A statement of conversion must be signed by the converting entity and delivered to the secretary of state for filing. (b) A statement of conversion must contain: (1) The name, jurisdiction of formation, and type of entity of the converting entity; (2) The name, jurisdiction of formation, and type of entity of the converted entity; (3) If the statement of conversion is not to be effective upon filing, the later date and time on which it will become effective, which may not be more than ninety (90) days after the date of filing; (4) If the converting entity is a domestic entity, a statement that the plan of conversion was approved in accordance with this part or, if the converting entity is a foreign entity, a statement that the conversion was approved by the foreign entity in accordance with the law of its jurisdiction of formation; (5) If the converted entity is a domestic filing entity, its public organic record, as an attachment; (6) If the converted entity is a domestic limited liability partnership, its statement of qualification, as an attachment; and (7) If the converted entity is a foreign entity, a statement designating a registered agent in compliance with section 30-21-411, Idaho Code. (c) In addition to the requirements of subsection (b) of this section, a statement of conversion may contain any other provision not prohibited by law. (d) If the converted entity is a domestic entity, its public organic record, if any, must satisfy the requirements of the law of this state, except that the public organic record does not need to be signed and may omit any provision that is not required to be included in a restatement of the public organic record. (e) A plan of conversion that is signed by a domestic converting entity and meets all the requirements of subsection (b) of this section may be delivered to the secretary of state for filing instead of a statement of conversion and on filing has the same effect. If a plan of conversion is filed as provided in this subsection, references in this chapter to a statement of conversion refer to the plan of conversion filed under this subsection. (f) A statement of conversion is effective on the date and time of filing or the later date and time specified in the statement of conversion. (g) If the converted entity is a domestic entity, the conversion is effective when the statement of conversion is effective. If the converted entity is a foreign entity, the conversion is effective on the later of: (1) The date and time provided by the organic law of the converted entity; or (2) When the statement is effective. Enclose the appropriate fee (make checks payable to Idaho Secretary of State): a. b. c. If the application is typed, the fee is $30.00. If the application is not typed, the fee is $50.00. If expedited service is requested, add $20.00 to the filing fee. Pursuant to Idaho Code § 67-910(6), the Secretary of State's Office may delete a business entity filing from our database if payment for the filing is not completed. Mail or deliver to: Office of the Secretary of State 450 N 4th Street PO Box 83720 Boise ID 83720-0080 (208) 334-2301 If you have questions or need help, call the Secretary of State's office at (208) 334-2301. American LegalNet, Inc. www.FormsWorkFlow.com 281 STATEMENT OF CONVERSION Pursuant to § 30­22­405, Idaho Code Filing fee: $30 typed, $50 not typed Complete and submit the form in duplicate. Note: Conversion documents are complex. Please seek appropriate legal and/or financial advice before making this important business decision. 1. CONVERTING ENTITY: Name: Jurisdiction: Type: (Corporation, Limited Liability Company, Limited Partnership, etc...) This is a domestic entity, and this plan of conversion was approved in accordance with § 30­22­405, Idaho Code. This is a foreign entity, and this plan of conversion was approved in accordance with the law of its jurisdication of formation. 2. CONVERTED ENTITY: Name: Jurisdiction: Type: (Corporation, Limited Liability Company, Limited Partnership, etc...) a. If this is a domestic entity or domestic limited liability partnership, please attach a copy of the entity's public organic record, or statement of qualification. b. If this is a foreign entity please designate a registered agent in the space provided: (Registered Agent Name) (Address) 3. EFFECTIVE DATE OF CONVERSION: Effective upon filing On future date: (Enter date ­ not more than 90 days in the future) Secretary of State use only Printed Name: Capacity: Signature: Revised 08/2015 American LegalNet, Inc. www.FormsWorkFlow.com