Form Cv 53-14 - Certificate Of Conversion - 2003
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1Contact Information
KANSAS SECRETARY OF STATE
CV
Kansas Secretary of State
Certificate of Conversion
Ron Thornburgh
53-14
Memorial Hall, 1st Floor
All information must be completed or this document will not be accepted for filing.
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-4564
Print
Reset
Please complete the form, print, sign and
A general partnership, limited liability partnership (LLP), limited partner-
mail to the Kansas Secretary of State with
ship (LP), limited liability limited partnership(LLLP), business trust/asso-
the filing fee. Selecting 'Print' will print
ciation, real estate investment trust, common-law trust, foreign limited li-
ability company, or any other unincorporated business may convert to a
the form and 'Reset' will clear the entire
Kansas LLC by certifying the following information:
form.
1. Date and jurisdiction where the entity was formed, and, if the jurisdiction
Do not write in this space
has changed, the jurisdiction immediately prior to this conversion:
___________________________________________________________________________________________________________
2. Name of the converting entity:
___________________________________________________________________________________________________________
3. Future effective date of conversion if not effective upon filing, but not later than 90 days after the filing date:
_________________
____________
___________
Month
Day
Year
4. Name of limited liability company:
5. This conversion was approved pursuant to the document, instrument, agreement or other writing governing the internal affairs of the
converting entity and the conduct of its business or by applicable law.
I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct.
Executed on the ________ of ___________ , _____________
.
Day
Month
Year
Authorized person
Instructions
1. Submit this form in duplicate with the $35 filing fee.
2. Attach articles of organization for the new LLC, form DL with the $165 filing fee.
Notice: There is a $25 service fee for all returned checks.
Rev. 8/11/03 amc
K.S.A. 17-7684
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