Combined Statement Of Conversion And Articles Of Organization Form - 2008
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4This version must be received on or before July 31, 2008.
Document processing fee
If document is filed on paper
$150.00
If document is filed electronically
$100.00
Fees & forms/cover sheets
are subject to change.
To file electronically, access instructions
for this form/cover sheet and other
information or print copies of filed
documents, visit
and select Business Center.
Paper documents must be typewritten or machine printed.
ABOVE SPACE FOR OFFICE USE ONLY
Combined Statement of Conversion and Articles of Organization
filed pursuant to
§7-90-201
and
§7-80-204
of the Colorado Revised Statutes (C.R.S.)
Statement of Conversion
1. For the converting entity, its entity name or true name, ID number (if applicable), form of entity, the
jurisdiction under the law of which it is formed, and the principal office address of its principal office are
Entity name or true name of
the converting entity
______________________________________________________
ID number (if applicable)
_________________________
(Colorado Secretary of State ID number)
Form of the entity
______________________________________________________
Jurisdiction where formed
______________________________________________________
Principal office street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________
(Province – if applicable)
(Country – if not US)
Principal office mailing address
______________________________________________________
(leave blank if same as above)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________.
(Province – if applicable)
(Country – if not US)
2. The converting entity has been converted into the resulting entity identified below.
CONVERT_LLC
Page 1 of 4
Rev. 7/21/2008
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