Form Mllc-Conv - Statement Of Conversion Page 2
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2SEVENTH: Result of Conversion (Select One)
The organizing document for the converted (resulting) organization is attached as Exhibit______, and made a
part hereof; or
The converted (resulting) is an organization not required to file with the Maine Secretary of State’s office.
Must Be Completed by the Converting Organization
Dated _________________________________
___________________________________________________
__________________________________________
(authorized signature)
(type or print name and capacity)
___________________________________________________
__________________________________________
(authorized signature)
(type or print name and capacity)
Filing Fee: If the converted (resulting) organization is a:
Business Corporation:
Filing fee is $145
Nonprofit Corporation:
Filing fee is $40
Limited Partnership:
Filing fee $175
Limited Liability Company:
Filing fee is $175
Limited Liability Partnership:
Filing fee is $175
Partnership:
Filing fee is $175
Pursuant to 31 MRSA
§§1647
and 1676.1, this Statement of Conversion must be signed by a person authorized by each constituent
organization that is party to this conversion.
The execution of this certificate constitutes an oath or affirmation, under the penalties of false swearing
under17-A MRSA
§453.
Please remit your payment made payable to the Maine Secretary of State.
Submit completed form to:
Secretary of State
Division of Corporations, UCC and Commissions
101 State House Station
Augusta, ME 04333-0101
Telephone Inquiries: (207) 624-7752
Email Inquiries:
CEC.Corporations@Maine.gov
Form No. MLLC-Conv (2 of 2) 7/1/2011
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