Articles Of Entity Conversion Of A Domestic Business Corporation To A Domestic Other Entity

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D
The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Articles of Entity Conversion of a
FORM MUST BE TYPED
FORM MUST BE TYPED
Domestic Business Corporation to a
Domestic Other Entity
(General Laws, Chapter 156D, Section 9.53;
950 CMR 113.29)
(1) Exact name of corporation prior to conversion _____________________________________________________________
(2) Registered offi ce address ______________________________________________________________________________
(number, street, city or town, zip code)
(3) Exact name of entity after conversion ____________________________________________________________________
(name must satisfy the organic law of the surviving entity)
(4) Type of entity that the surviving entity will be _____________________________________________________________
(5) Th e plan of entity conversion was duly approved by the shareholders and if voting by any separate voting group was required,
by each separate voting group in the manner required by General Laws Chapter 156D and the articles of organization.
(6) Attach additional sheets containing all information required to be set forth in the public organic document of the surviving
entity.
(7) Th e eff ective date of conversion of the corporation shall be the date approved and fi led by the Secretary of the Common-
wealth. If a later eff ective date is desired, specify such date, which may not be later than the 90
day after the articles are
th
received for fi ling. __________________________________________________________________________________
Signed by ____________________________________________________________________________________________
Signed by ____________________________________________________________________________________________
Signed by
,
(signature of authorized individual)
(
(
(
Please check appropriate box)
Please check appropriate box)
Chairman of the Board of Directors
President
Other Offi cer
Court-appointed fi duciary, on this
on this ________________________ day of______________________________________
day of______________________________________
day of
of _______________________
of _______________________
of
P.C.
156d953 7/29/04

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