Form All Entity-1a Certificate Of Conversion For All Entity Types

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State of California
File#_________________________
Bill Jones
Secretary of State
CERTIFICATE OF CONVERSION
FOR ALL ENTITY TYPES
IMPORTANT – Read all instructions before completing this form.
This Space For Filing Use Only
1.
Name of the converting entity/partnership:
2.
Structure of the converting entity/partnership:
3.
California Secretary of State file number of the converting entity/partnership, if any:
4.
Jurisdiction of formation of the converting entity/partnership:
5.
Name of converted entity/partnership:
6.
Structure of converted entity/partnership:
7.
Jurisdiction of formation of the converted entity/partnership:
8.
Mailing address of chief executive office of converted entity/partnership:
City
State
Zip
9.
Street address of chief executive office of converted entity/partnership:
City
State
Zip
10. Street address of the California office of converted entity/partnership, if any:
City
State
Zip
11. Mailing address of the agent for service of process:
City
State
Zip
12.
The principal terms of the plan of conversion were approved by a vote of the partners/members, which equaled or exceeded the vote
required.
13.
If a vote was required pursuant to section 15677.3 or 17540.3, enter the outstanding interest of each class entitled to vote on the
conversion and the percentage of vote required:
Name of entity/partnership
Each class entitled to vote
Percentage of vote required
14. I certify that the statements contained in this document are true and correct to my own knowledge. I declare that I am the person
who is executing this instrument, which execution is my act and deed.
_____________________________________________________
___________________________________________________
Signature of Authorized Person of Converting Entity
Date Executed
________________________________________
______________________________________
Type or Print Name and Title of Authorized Person
County and State Executed
________________________________________
______________________________________
Signature of Authorized Person of Converting Entity
Date Executed
________________________________________
______________________________________
Type or Print Name and Title of Authorized Person
County and State Executed
SEC/STATE FORM ALL ENTITY-1A (REV. 3/00)
Approved by Secretary of State

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