Certificate Of Conversion From A Delaware Or Non-Delaware Corporation To A Delaware Limited Liability Company - Delaware Division Of Corporations Page 2

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STATE OF DELAWARE
CERTIFICATE OF CONVERSION
FROM A CORPORATION TO A
LIMITED LIABILITY COMPANY PURSUANT TO
SECTION 18-214 OF THE LIMITED LIABILITY ACT
1.) The jurisdiction where the Corporation first formed is
___________________.
2.) The jurisdiction immediately prior to filing this Certificate is______________.
3.) The date the corporation first formed is
_______________________________.
4.) The name of the Corporation immediately prior to filing this Certificate is
_______________________________________________________________.
5.) The name of the Limited Liability Company as set forth in the Certificate of
Formation is _____________________________________________________.
IN WITNESS WHEREOF, the undersigned have executed this Certificate on the
___________day of _________________, A.D._______________.
By:____________________________
Authorized Person
Name:____________________________
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