Form Cvf 53-45 - Certificate Of Conversion To A Foreign Entity - Secretary Of State Page 2

This conversion is approved in accordance with K.S.A. 17-78-401 through 17-78-406 and amendments thereto.

I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct and that I

have remitted the required fee.

____________________________________________________________

_________________________________

Signature of authorized person of the converting entity

Date

____________________________________________________________

______________________________________________

Name of signer, printed or typed

Title

Instructions:

1. Submit this form with the $75 filing fee. Make checks payable to the Kansas Secretary of State.

2. If the tax closing month has passed, please submit an annual report and fee along with this form.

NOTICE:

There is a $25 service fee for all checks returned by your financial institution.

Page 2 of 2

Rev. 12/27/10 jdr

K.S.A . 17-78-401 - K.S.A. 17-78-406

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