Combined Statement Of Conversion And Articles Of Organization Form - 2008 Page 3
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4Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________.
(Province – if applicable)
(Country – if not US)
3. The registered agent name and registered agent address of the initial registered agent are
Name
(if an individual)
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
OR
(if an entity)
______________________________________________________
(Caution: Do not provide both an individual and an entity name.)
The person appointed as registered agent above has consented to being so appointed.
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________
CO
____________________
(City)
(State)
(Postal/Zip Code)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________
CO
____________________.
(City)
(State)
(Postal/Zip Code)
4. The true name and mailing address of the person forming the limited liability company are
Name
(if an individual)
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
OR
(if an entity)
______________________________________________________
(Caution: Do not provide both an individual and an entity name.)
Mailing address
______________________________________________________
(Street number and name or Post Office Box information)
______________________________________________________
_
_
__
__________________________
____________________
(City)
(State)
(Postal/Zip Code)
_______________________ ______________.
(Province – if applicable)
(Country – if not US)
(If the following statement applies, adopt the statement by marking the box and include an attachment.)
This document contains the name and address of one or more additional person(s) forming the
limited liability company.
CONVERT_LLC
Page 3 of 4
Rev. 7/21/2008
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