Form X-10 - Articles Of Conversion (Page 2 of 2) in pdf

Form X-10 - Articles Of Conversion Page 2

FORM X-10

7/2000

Complete the applicable section. The Plan of Conversion was approved by the converting entity as follows:

By vote of the shareholders of the converting domestic/professional corporation:

Number of Shares

Number of Shares Voting

Class/Series

Outstanding

For Conversion

Against Conversion

By vote of the converting limited liability company:

Number of Votes

Total Number of Authorized Votes

For the Conversion

Against the Conversion

The converting entity was either a foreign profit corporation, domestic or foreign nonprofit corporation, general or

limited partnership, or limited liability partnership. The approval of the Plan of Conversion was duly authorized and

complied with the laws under which the converting entity was incorporated, formed, organized, or qualified.

I certify under the penalties of Section 415-136, 415A-25, 415B-158, 425-13, 425D-204, 425D-1108, Hawaii Uniform Limited

Liability Company Act, and Hawaii Limited Liability Partnership Act, Hawaii Revised Statutes, as applicable, that I have read the

above statements and that the same are true and correct.

Signed this ____________day of ___________________________________, __________

______________________________________________________

_________________________________________________________

(Type/Print Name & Title)

(Signature)

SEE INSTRUCTIONS ON REVERSE SIDE. The articles must be signed by an officer, partner, or other duly authorized

representative of the converting entity.

Form X-10 - Articles Of Conversion Page 2