Form Ss-4268 - Certificate Of Conversion (Another Business Entity Into Llc) printable pdf download

Form Ss-4268 - Certificate Of Conversion (Another Business Entity Into Llc)

For Ofﬁ ce Use Only

CERTIFICATE OF CONVERSION

(Another Business Entity into LLC)

Corporate Filings

312 Eighth Avenue North

Floor, William R. Snodgrass Tower

Nashville, TN 37243

Pursuant to the provisions of §48-249-703 of the Tennessee Revised Limited Liability Company

Act, the undersigned Limited Liability Company hereby submits this certiﬁ cate of conversion:

1. The name of the domestic limited liability company as set forth in its articles of organization is:

2. The name of the converting other business entity immediately prior to the ﬁ ling of the certiﬁ cate

of conversion is:

3. The jurisdiction in which the converting other business entity was formed is

its date of formation is

(month/day/year), and its business type is a

4. All required approvals of the conversion have been obtained by the other business entity.

5. If the conversion is not to be effective upon the ﬁ ling of the certiﬁ cate of conversion and articles

of organization, then the future effective date or time of the conversion to a domestic LLC is:

Date: ______________________ , _______________ Time ___________________

Signature date

Signature

Signer’s capacity

Name (typed or printed)

Filing Fee $20

SS-4268 (Rev. 06/07)

RDA 2458

Form Ss-4268 - Certificate Of Conversion (Another Business Entity Into Llc)