Statement of Abandonment of Plan of Conversion: All Entity Types 08-0589 New 07/01/2014 Instructions Page 1 of 2 These instructions and the attached form 08-602 are specifically for STATEMENT OF ABANDONMENT OF PLAN OF CONVERSION Under the Alaska Entity Transaction Act AS 10.55.404 $25.00 Filing Fee (non-refundable) INSTRUCTIONS FOR STATEMENT OF ABANDONMENT (Please retain for your records): WHAT IS A CONVERSION? Conversion is when an entity changes/transforms from one type of entity into a different type of entity by means of a transaction authorized by AS 10.55.401-10.55.406. NOTE: Pursuant to Alaska Statutes 10.55.405(c), after a plan of conversion has been approved by the domestic (Alaskan) converting (changing from one entity type to a different entity type) entity and before a statement of conversion becomes effective, the plan of conversion may be abandoned by submitting the following Abandonment of Plan of Conversion: ITEM 1: Provide the converting (changing from) entity name, and the Alaska Entity Number (if applicable), the domicile or jurisdiction (home state), and the entity type. NOTE: the name must match the name of the converting entity in the plan of conversion or in Item # 1 on the Statement of Conversion. ITEM 2: A Statement of Abandonment can only be filed after a plan of conversion or Statement of Conversion has been filed with the department and before it becomes effective. (Note: the effective date is the date filed for record with this division or a future effective date if provided in the Statement of Conversion.) ITEM 3: This statement is required by statute. Please read through and verify. ITEM 4: The statement must be signed on behalf of the converting (changing from) entity (listed in Item #1 on the Statement of Abandonment of Plan of Conversion) in the following manner: (a) If the converting entity is a corporation, by an officer of the corporation; (b) If the converting entity is not a corporation, the person authorized by the entity; or (c) If the converting entity is in the hands of a receiver, trustee, or other court-appointed fiduciary, by that fiduciary. If the converting (changing from) entity is currently on record with this division (has an AK Entity Number) and the signer is an official of the entity then the signer must be currently on record with the division. Provide the printed name of the signer, the full title/capacity of the authorized signer, the name of the entity that the individual is representing, and signature of the individual authorized to sign. Corporations Section State Office Building, 333 Willoughby Avenue, 9th Floor PO Box 110806, Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Email: corporations@alaska.gov Website: http://commerce.alaska.gov/cbpl/corp ALASKADepartment of Commerce, Community, and Economic DevelopmentDivision of Corporations, Business and Professional Licensing THESTATEof American LegalNet, Inc. www.FormsWorkFlow.com Statement of Abandonment of Plan of Conversion: All Entity Types 08-0589 New 07/01/2014 Instructions Page 2 of 2 NOTE - Signatures: Per AS 10.55.609, persons who sign documents to be filed with the commissioner that are known by the person to be false in material respects are guilty of a class A misdemeanor. SUBMITTAL: Please submit forms and payment together. Mail the Statement of Abandonment of Plan of Conversion (form 08-589) and the 25.00 non-refundable filing fee in U.S. dollars to: o State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806 If faxing the form please include the Credit Card Payment form with the appropriate fees. Do not email forms or payment. STANDARD PROCESSING TIME for complete and correct applications submitted to this office is approximately 10-15 business days. All applications are reviewed in the date order they are received. ADDITIONAL RESOURCES: Professional Licensing Section: For information regarding what professions require a professional license, statutes, how to obtain a professional license, and/or the expiration date if you already have a professional license, visit the Professional Licensing website at http://commerce.alaska.gov/cbpl/pl. NOTICE: if a professional license is owned by an entity and there is a change in the entity then the professional license may be impacted. Contact the appropriate professional licensing examiner. Business Licensing Section: For the privilege of engaging in a business in the State of Alaska, a business license is required for a new entity. For information regarding business licenses, statutes, and how to obtain a business license, visit the Business Licensing website at http://commerce.alaska.gov/cbpl/bl. NOTE: a change in the ownership of a business license requires a new business license. Alaska Corporate Net Income Tax: Every corporation earning gross income from sources within the state, except for those corporations that are specifically exempted, must file a corporation net income tax return. Contact the Alaska Department of Revenue, Tax Division, PO Box 110420, Juneau, Alaska, 99811-0420, telephone number (907) 465-2320 for more information. American LegalNet, Inc. www.FormsWorkFlow.com Statement of Abandonment of Plan of Conversion: All Entity Types 08-0589 New 07/01/2014 Page 1 of 2 Specifically for STATEMENT OF ABANDONMENT OF PLAN OF CONVERSION All Entity Types Under the Alaska Entity Transaction Act AS 10.55.405(c) $25.00 Filing Fee (non-refundable) ($25 Corp Fee) Pursuant to Alaska Statutes 10.55.405(c), after a plan of conversion has been approved by the domestic (Alaskan) converting (changing from one entity type to a different entity type) entity and before a statement of conversion becomes effective, the plan of conversion may be abandoned by submitting the following Abandonment of Plan of Conversion: ITEM 1: Name of converting (changing from) entity: Alaska Entity # (if applicable): (This must match the name of the converting entity in the plan of conversion or in Item # 1 on the Statement of Conversion.) State of Domicile or Jurisdiction (home state): Type of Entity: ITEM 2: The date on which the plan of conversion or the Statement of Conversion, with a future effective date, was filed for record with this division (mm/dd/yyyy format): // ITEM 3: The conversion has been abandoned in accordance with AS 10.55.405. ITEM 4: The Statement of Abandonment must be signed on behalf of the converting entity (listed in Item # 1 above). If the entity is a corporation, it must be signed by an officer of the corporation. If the entity is not a corporation, it must be signed by the person authorized by the entity. If the entity is in the hands of a receiver, trustee, or other court-appointed fiduciary, it must be signed by the fiduciary. Item 4 Continued on Next Page COR Corporations Section State Office Building, 333 Willoughby Avenue, 9th Floor PO Box 110806, Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Email: corporations@alaska.gov Website: http://commerce.alaska.gov/cbpl/corp THE STATE ALASK A ofDepartment of Commerce, Community, and Economic DevelopmentDivision of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com Statement of Abandonment of Plan of Conversion: All Entity Types 08-0589 New 07/01/2014 Page 2 of 2 ITEM 4 CONTINUED: If the converting entity is a currently on record with this division (has an AK Entity Number) and the signer is an official of the entity then the signer must be currently on record with this division. Provide the printed name of the signer, the full title/capacity of the authorized signer, the name of the entity that the individual is representing, and signature of the individual authorized to sign. Signature Printed Name Title and entity that represented Date NOTE - Signatures: Per AS 10.55.609, persons who sign documents to be filed with the commissioner that are known by the person to be false in material respects are guilty of a class A misdemeanor. SUBMITTAL: Please submit forms and payment together. Mail the Statement of abandonment of Plan of Conversion (form 08-589) and the $25.00 non-refundable filing fee in U.S. dollars to: o State of Ala