Form Cvf 53-45 - Certificate Of Conversion To A Foreign Entity - Secretary Of State
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1
2KANSAS SECRETARY OF STATE
CVF
Certificate of Conversion to
a Foreign Entity
53-45
Kansas Entity Converting into a
Foreign Entity
Kansas Office of the Secretary of State
CONTACT:
Memorial Hall, 1st Floor
(785) 296-4564
120 S.W. 10th Avenue
kssos@sos.ks.gov
Topeka, KS 66612-1594
Above space is for office use only.
INSTRUCTIONS:
All information must be completed or this document will not be accepted for filing.
i
Please read instructions before completing.
Converting Entity
1. Business entity ID
number:
This is not the Federal Employer
_______________________________________
ID Number (FEIN)
2. Entity name:
_____________________________________________________________________________________
3. Type of entity:
___ For-Profit Corporation
___ General Partnership
___ Limited Liability Partnership
___ Not-for-Profit Corporation
___ Limited Liability Company
___ Limited Partnership
New Entity
4. Entity name:
_____________________________________________________________________________________
5. Type of entity:
___ For-Profit Corporation
___ General Partnership
___ Limited Liability Partnership
___ Not-for-Profit Corporation
___ Limited Liability Company
___ Limited Partnership
6. State or country of
organization to which
the entity is converted:
_______________________________________
I hereby appoint the Kansas Secretary of State as agent for service of process.
7. Service of process
may be delivered to:
______________________________________________________________________________________
Must be a street address.
Name
Street Address
A P.O. box is unacceptable.
______________________________________________________________________________________
City
State
Zip
Country
8. Effective date:
Upon filing
__________________________
Future effective date (cannot exceed 90 days from the file date)
Month
Day
Year
Page 1 of 2
Rev. 12/27/10 jdr
K.S.A . 17-78-401 - K.S.A. 17-78-406
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