Form C-5 - Certificate Of Conversion Of A Foreign Limited Liability Company To A New Hampshire Limited Liability Company

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State of New Hampshire
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Filing fee: (SEE TOTAL FEES AT BOTTOM OF PAGE)
Form C-5
Use black print or type.
RSA 304-C:17-a
Form must be single-sided, on 8½” x 11” paper;
double sided copies will not be accepted.
CERTIFICATE OF CONVERSION OF A
FOREIGN LIMITED LIABILITY COMPANY TO A
NEW HAMPSHIRE LIMITED LIABILITY COMPANY
PURSUANT TO THE PROVISIONS OF THE NEW HAMPSHIRE LIMITED LIABILITY COMPANY
STATUTES, THE UNDERSIGNED FOREIGN LIMITED LIABILITY COMPANY SUBMITS THE
FOLLOWING CERTIFICATE OF CONVERSION:
FIRST: The jurisdiction where the foreign limited liability company first formed is
.
SECOND: The jurisdiction immediately prior to filing this certificate is
.
THIRD: The date the foreign limited liability company first formed is
.
FOURTH: The name of the foreign limited liability company immediately prior to filing this
certificate is
.
FIFTH: The name of the limited liability company as set forth in the certificate of formation is
.
SIXTH: The plan of conversion is on file at the principle place of business of the limited liability
company and the address thereof and that a copy of the plan of conversion will be furnished by the
limited liability company, on request and without cost, to any interest holder of the limited liability
company.
(Limited Liability Company name)
(Note 1)
(Signature)
(Print or type name)
(Note 1)
(Title)
Date signed:
Note: 1. Must be signed by a manager, if there is no manager then it must be signed by a member.
See RSA 304-C:2 VI for alternative signatures.
DISCLAIMER: All documents filed with the Corporate Division become public records and will be available for
public inspection in either tangible or electronic form.
MAIL DATED AND SIGNED ORIGINAL WITH CERTIFICATE OF FORMATION OF NEW HAMPSHIRE
LIMITED LIABILITY COMPANY (FORM LLC-1), FORM SRA AND TOTAL FEES OF $135.00 to: Corporate
Division, Department of State, 107 North Main Street, Concord, NH 03301-4989.
Form C-5 (9/2010)

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