Statement of Conversion: Domestic Entity without AK Entity # Converting to a Foreign LLC 08-0579 New 07/01/2014 Instructions Page 1 of 5 STATEMENT OF CONVERSION Specifically for A Domestic (Alaskan) Entity without an AK Entity Number Converting to a Foreign (non-Alaskan) Limited Liability Company which will continue to conduct business in Alaska as a qualified (on record with the division) Foreign Limited Liability Company Under the Alaska Entity Transaction Act AS 10.55.401-10.55.406 and AS 10.50.615 $375.00 filing fee. $ 25.00 Statement of Conversion (non-refundable) $350.00 Registration of Foreign LLC (non-refundable) INSTRUCTIONS FOR STATEMENT OF CONVERSION (Please retain for your records): IMPORTANT: This form is to be used only if the foreign (non-Alaskan) limited liability company (listed in Item # 2 on the Statement of Conversion) will continue to be doing business in Alaska. If the converted foreign limited liability company will not be doing business in Alaska, then you must use form 08-588, Any Domestic (Alaskan) Entity Converting to an Unqualified Domestic (Alaskan) or Foreign (Non-Alaskan) Entity Not Conducting Business in Alaska. WHAT IS A CONVERSION? Conversion (when an entity changes/transforms from one type of entity into a different type of entity) means a transaction authorized by AS 10.55.401-10.55.406, with the exception of the entities excluded under AS 10.55.110. Under this: Any domestic (Alaskan) entity may convert to a foreign (non-Alaskan) limited liability company if the conversion is authorized by the law of the foreign jurisdiction. NOTICE: The Statement of Conversion must be filed in conjunction with Certificate of Registration (attached to this form) for a Foreign (non-Alaskan) Limited Liability Company and the applicable $350.00 fee (which are already included in the above stated filing fees). ITEM 1: Provide the name of the converting (changing from) domestic (Alaskan) entity and the type of entity (changing from). ITEM 2: Provide the name of the converted (changing to) foreign (non-Alaskan) limited liability company (which will continue to conduct business in the State of Alaska after the conversion), and the state of domicile or jurisdiction. 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 Conversion: Domestic Entity without AK Entity # Converting to a Foreign LLC 08-0579 New 07/01/2014 Instructions Page 2 of 5 A limited liability company name must contain the words 223limited liability company224 or the abbreviation of 223L.L.C224 or 223LLC.224 The word 223limited224 may be abbreviated as 223Ltd.224 and the word 223company224 may be abbreviated as 223Co.224 The name of a city, borough, or village may be used in a limited liability company name; however, the name may not contain the word 223city,224 223borough,224 or 223village224 or otherwise imply that the company is a municipality. The company name may not contain a word or phrase that indicates or implies that the company is organized for a purpose other than the purpose contained in its articles of organization. A limited liability name must be distinguishable upon the record. To search the availability of the legal name of the corporation in the State of Alaska go to the above website, click License Search, and select Search Corporations Database. NOTE: the name of the converted limited liability company in Item #2 on the Statement of Conversion must match the name in Item #1 on the Certificate of Registration attached to this filing. ITEM 3: (Optional) The future effective date of conversion, if different from date of filing, must be a specific future date and cannot exceed 90 days from date of filing. Future effective date (mm/dd/yyyy format). ITEM 4: This statement is required by statute. Please read through and verify. ITEM 5: The converted (changing to) entity is a foreign (non-Alaskan) limited liability company, which will continue to be conducting business in Alaska as a foreign limited liability company after the conversion, must complete the Certificate of Registration attached to this form. ITEM 6: The Statement of Conversion must be signed on behalf of the converting (changing from) entity (listed in Item #1 above) in the following manner: 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 said entity. If the entity is in the hands of a receiver, trustee, or other court-appointed fiduciary, it must be signed by said fiduciary. 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. 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. NOTE - Plan of Conversion -OR- Statement of Conversion: Do not send both together. Submit either the Statement of Conversion OR the plan of conversion that is signed on behalf of all entities and contains all the information required to be in the Statement of Conversion and is delivered to the Division for filing after the plan has been adopted and approved by all entities. Sending both the plan of conversion and the Statement of Conversion together may cause delays in processing time. SUBMITTAL: Please submit forms and payment together. Mail the Statement of Conversion (form 08-579) and the $375.00 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. American LegalNet, Inc. www.FormsWorkFlow.com Statement of Conversion: Domestic Entity without AK Entity # Converting to a Foreign LLC 08-0579 New 07/01/2014 Instructions Page 3 of 5 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. IMPORTANT: This form is to be used only if the foreign (non-Alaskan) limited liability company (listed in Item # 2 on the Statement of Conversion) will continue to be doing business in Alaska. If the converted foreign limited liability company will not be doing business in Alaska, then you must use form 08-588, Any Domestic (Alaskan) Entity Converting to an Unqualified Domestic (Alaskan) or Foreign (Non-Alaskan) Entity Not Conducting Business in Alaska. INSTRUCTIONS FOR CERTIFICATE OF REGISTRATION These instructions are specific for the Certificate of Registration which must be attached to the Statement of Conversion (form 08-579) ITEM 1: Legal Name of the Limited Liability Company Provide the name of the foreign (non-Alaskan) limited liability company: A limited liability company name must contain the words 223limited liability company224 or the abbreviation of 223L.L.C224 or 223LLC.224 The word 223limited224 may be abbreviated as 223Ltd.224 and the word 223company224 may be abbreviated as 223Co.224 The name of a city, borough, or village may be used in a limited liability company name; however, the name may not contain the word 223city,224 223borough,224 or 223village224 or otherwise imply that the company is a municipality. The company name may not contain a word or phrase that indicates or implies that the company is organized for a purpose other than the purpose contained in its articles of organization. A limited liability name must be distinguishable upon the record. To search the availability of the legal name of the corporation in the State of Alaska go to the above website, click License Search, and select Search Corpora