Form Conv - Certificate Of Conversion Page 2
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2(MUST BE COMPLETED BY THE CONVERTING BUSINESS ENTITY)
_______________________________________________________________________
______________________________
Name and Type of Participating Business Entity
Dated
____________________________________________________
_____________________________________________
Authorized Signature
Type or Print Name and Capacity
____________________________________________________
_____________________________________________
Authorized Signature
Type or Print Name and Capacity
(MUST BE COMPLETED BY THE CONVERTING BUSINESS ENTITY, IF A CORPORATION)
The address of the registered office, including the street, city, state and zip code, in the State of Maine is as follows:
________________________________________________________________________________________________________________
(MUST BE COMPLETED BY THE CONVERTING BUSINESS ENTITY, IF A DOMESTIC CORPORATION)
The undersigned clerk, secretary or assistant secretary certifies that he/she has custody of the minutes showing the above action by the
shareholders.
____________________________________________________
_____________________________________________
Authorized Signature
Type or Print Name and Capacity
MUST BE COMPLETED BY THE RESULTING BUSINESS ENTITY
THE UNDERSIGNED HEREBY ACCEPTS THE APPOINTMENT AS CLERK/REGISTERED AGENT FOR
THE RESULTING BUSINESS ENTITY.
CLERK/REGISTERED AGENT
DATED __________________________
___________________________________________________
____________________________________________________
)
(signature)
(type or print name
For Registered Agent which is a Corporation
Name of Corporation ______________________________________________________________________________________________
By ________________________________________________
____________________________________________________
(authorized signature)
(type or print name and capacity)
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. CONV Rev. 4/16/2001
TEL. (207) 624-7740
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Parent category: Legal