Articles Of Entity Conversion Of A Domestic Business Corporation To A Domestic Other Entity Page 2

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COMMONWEALTH OF MASSACHUSETTS
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Boston, Massachusetts 02108-1512
Articles of Entity Conversion
(General Laws, Chapter 156D, Section 9.53)
I hereby certify that upon examination of these Articles of Conversion, duly
submitted to me, it appears that the provisions of the General Laws relative
to thereto have been complied with, and I hereby approve said articles; and
the fi ling fee in the amount of $______ having been paid, said articles are
deemed to have been fi led with me this
_____________ day of ______________
day of ______________
day of
20_______ at _______a.m./p.m.
time
Eff ective date: _________________________________________________
(must be within 90 days of date submitted)
Examiner
WILLIAM FRANCIS GALVIN
Secretary of the Commonwealth
Name approval
C
TO BE FILLED IN BY CORPORATION
Contact Information:
M
___________________________________________________________
___________________________________________________________
___________________________________________________________
Telephone: ___________________________________________________
Email: ______________________________________________________
A copy of this fi ling will be available on-line at once
once
the document is fi led.

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