Statement Of Conversion Converting A Domestic Entity Into A Foreign Entity
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3Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Conversion Converting a Domestic Entity into a Foreign Entity
filed pursuant to § 7-90-201.7 (2) and § 7-90-204.5 of the Colorado Revised Statutes (C.R.S.)
1. For the converting entity, its true name, form of entity, jurisdiction under the law of which it is formed, and
principal address are
True name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
Colorado
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
2. For the resulting entity, its true name, form of entity, jurisdiction under the law of which it is formed, and
principal address are
True name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
CONV_FOR_2
Page 1 of 3
Rev. 2/26/2008
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