Form Conv - Articles/certificate Of Conversion Page 2
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1
2Must Be Completed By The Resulting Business Entity
The undersigned hereby accepts the appointment as registered agent for the resulting business entity.
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)
Instructions For Required Signatures
Resulting Business Entity
The Registered Agent must complete an acceptance of appointment form.
Limited Partnerships
If this is a limited partnership, this document MUST be signed by
(1) at least one general partner OR
(2) any duly authorized person.
The execution of this certificate constitutes an oath or affirmation, under the penalties of false swearing under
17-A MRSA
§453.
Limited Liability Companies
If this is a limited liability company, this document MUST be signed by
(1) at least one manager OR
(2) at least one member if the limited liability company is managed by the members OR
(3) any duly authorized person.
The execution of this certificate constitutes an oath or affirmation, under the penalties of false swearing under
17-A MRSA
§453.
Please remit your payment made payable to the Maine Secretary of State.
SUBMIT COMPLETED FORMS TO: CORPORATE EXAMINING SECTION, SECRETARY OF STATE,
101 STATE HOUSE STATION, AUGUSTA, ME 04333-0101
FORM NO. CONV (2 of 2) Rev. 8/1/2004
TEL. (207) 624-7740
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Parent category: Legal