Form Mbca-21a - Articles Of Entity Conversion - Maine Secretary Of State
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1Filing Fee $145.00
DOMESTIC OR FOREIGN
UNINCORPORATED ENTITY
STATE OF MAINE
ARTICLES OF ENTITY CONVERSION
_____________________
Deputy Secretary of State
A True Copy When Attested By Signature
______________________________________
_____________________
(Name of Unincorporated Entity Prior to Conversion)
Deputy Secretary of State
Pursuant to
13-C MRSA §955.2
or §955.3, the undersigned unincorporated entity executes and delivers the following Articles of Entity
Conversion:
FIRST:
The name of the unincorporated entity is changed as follows (the name must satisfy the requirements of
13-C MRSA
§401):
_______________________________________________________________________________________________
SECOND:
(Foreign Unincorporated Entity Only)
The unincorporated entity was organized in (state or country)
________________________________ and the date of organization was ___________________.
THIRD:
("X" one box only.)
(Domestic Unincorporated Entity) The plan of entity conversion was duly approved in accordance with
the organic law of the unincorporated entity.
(Foreign Unincorporated Entity) The conversion of the unincorporated entity was duly approved in the
manner required by its organic law.
FOURTH:
All the statements required to be set forth in Articles of Incorporation (Form MBCA-6-1) are attached as Exhibit
________.
FIFTH:
The effective date of the articles of entity conversion (if other than the date of filing of the articles of entity
conversion) is _______________________________.
DATED _________________________
*By __________________________________________________
(signature of an officer or other duly authorized representative)
__________________________________________________
(type or print name and capacity)
*This document MUST be signed by an officer or other duly authorized representative.
(13-C MRSA §955.2
or §955.3)
Please remit your payment made payable to the Maine Secretary of State.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. MBCA-21A (1 of 1) Rev. 8/1/2004
TEL. (207) 624-7740
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