State Form 51577 - Articles Of Entity Conversion - Indiana Limited Liability Company - 2016 Page 2
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3ARTICLES OF ENTITY CONVERSION
CONVERSION OF AN INDIANA NON-CORPORATION
BUSINESS ENTITY INTO AN INDIANA LIMITED LIABILITY
COMPANY
State Form 51577 (R4 / 7-16)
Approved by State Board of Accounts, 2016
Indiana Code 23-1-18-3
FILING FEE: $30.00
ARTICLES OF CONVERSION
OF
____________________________________________________________________________
(hereinafter “Non-surviving Business Entity”)
INTO
____________________________________________________________________________
(hereinafter “Surviving LLC”)
ARTICLE I: PLAN OF ENTITY CONVERSION
a.
Please set forth the Plan of Conversion, containing such information as required by Indiana Code 23-1-38.5-11, attach herewith, and designate it as
“Exhibit A.”
The plan must specify the following:
A statement indicating that the type of business entity the surviving entity will be is an LLC;
The terms and conditions of the conversion;
The manner and basis of converting the interests, securities, obligations, rights to acquire interests or other securities of Non-surviving
Business Entity following its conversion into the shares of Surviving LLC; and
The full text, as in effect immediately after the consummation of the conversion, of the organic documents, if any, of Surviving LLC.
b.
Please read and sign the following statement.
I hereby affirm under penalty of perjury that the plan of conversion is in accordance with the organic document of Non-surviving Business Entity and
is duly authorized as required by the laws of the State of Indiana.
Signature
Printed Name
Title
ARTICLE II: NAME AND TYPE OF NON-SURVIVING BUSINESS ENTITY
a.
The name of Non-surviving Business Entity immediately before filing these Articles of Entity Conversion is the following:
b.
Please state the type of business entity of Non-surviving Business Entity below.
ARTICLE III: NAME AND PRINCIPAL OFFICE OF SURVIVING LLC
a.
The name of Surviving LLC is the following
(Please note pursuant to Indiana Code 23-18-2-8, this name must include the words “Limited Liability Company”, “L.L.C.”, or “LLC”.)
b.
The address of Surviving LLC’s Principal Office is the following:
Street Address (number and street)
City
State
ZIP code
ARTICLE IV: REGISTERED OFFICE AND AGENT OF SURVIVING LLC
Registered Agent: The name and street address of Surviving LLC’s Registered Agent and Registered Office for service of process are the following:
Name of Registered Agent
Address of Registered Office (number and street or building)
City
State
ZIP code
Indiana
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