Articles Of Entity Conversion Of A Domestic Business Corporation To A Domestic Other Entity - Commonwealth Of Massachusetts

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D
The Commonwealth of Massachusetts
PC
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Articles of Entity Conversion of a
FORM MUST BE TYPED
FORM MUST BE TYPED
Domestic Business Corporation to a
Domestic Other Entity
(General Laws Chapter 156D, Section 9.53; 950 CMR 113.29)
(1) Exact name of corporation prior to conversion: ____________________________________________________________
(2) Registered offi ce 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) Th e 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 surviv-
ing entity.
(7) Th e conversion of the corporation shall be eff ective at the time and on the date approved by the Division, unless a later eff ec-
tive date is specifi ed 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 offi cer,
® Court-appointed fi duciary,
on this _________________________ day of_________________________________________
day of_________________________________________
day of
, _____________________
P.C.
c156ds953950c11329 07/19/05

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