Certificate Of Conversion (LLC Into Another Business Entity) {SS-4269}

For Office Use Only CERTIFICATE OF CONVERSION (LLC into another Business Entity) Corporate Filings 312 Rosa L. Parks Ave. 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 Pursuant to the provisions of §48-249-704 of the Tennessee Revised Limited Liability Company Act, the undersigned Limited Liability Company submits this certificate of conversion: 1. The current name of the of the domestic limited liability company (hereinafter referred to as the domestic LLC) is: . If different, the name of the domestic LLC under which its articles of organization were originally filed is: . 2. The date of filing of the original articles of organization of the domestic LLC was: (month/day/year). 3. The name of the other business entity into which the domestic LLC is to be converted is business type is a , its jurisdiction of formation is . , and its 4. All required approvals of the conversion have been obtained by the domestic limited liability company. 5. If the conversion is not to be effective upon the filing of the certificate of conversion, then the future effective date or time of the conversion is: Date: , Time 6. The following box must be checked and the mailing address provided if the domestic LLC is converting to a foreign entity: The foreign entity agrees that it may be served with process in this State in any proceeding for the enforcement of any obligation of the domestic LLC arising prior to the date of the conversion, irrevocably appointing the Secretary of State as its agent to accept service of process in any such proceeding. The address (including zip code) to which a copy of such process shall be mailed to it by the Secretary of State is: . Signature date Signature Signer's capacity Name (typed or printed) Filing Fee $20 SS-4269 (Rev. 06/07) RDA 2458 American LegalNet, Inc. www.FormsWorkFlow.com