New Entity File NumberFiling Fee: $100 Approved: 204204204204204Submit in duplicate204204204204204 Type or print clearly in black ink204204204204204Do not write above this line 204204204204204Converting EntityCurrent file number:1.Converting Entity Name:2.Current Entity Type: (select only one)002For Profit Corporation 002Limited Liability Company 002General Partnership002Limited Liability Partnership 002Limited Partnership3.State and Date of Incorporation/Organization:4.Date of Conversion:New Entity5.Converted Entity Name:6.Converted Entity Type: (select only one)002For Profit Corporation 002Limited Liability Company 002General Partnership002Limited Liability Partnership 002Limited Partnership7.State or Jurisdiction of Incorporation/Organization:8.Address for Service of Process:9.Effective Date of Conversion:If a future date is chosen, MUST be within 90 days of filing.002Upon Filing 002Future Effective Date:The Conversion was approved in accordance with Section 205 of the Entity Omnibus Act.The formation document and fee for the Converted Entity must be attached.10. The undersigned Entity has caused this statement to be signed by a duly authorized signer who affirms, under penaltiesof perjury, that the facts stated herein are true and correct. All signatures must be in BLACK INK.Dated ,Month & Day Year Exact Name of Entity Any Authorized Signer220s Signature Name and Title (type or print) Printed by authority of the State of Illinois. June 2018 204 1 204 C 349.1EOA 205Illinois Secretary of StateDepartment of Business ServicesSTATEMENT OF CONVERSIONSecretary of State Department of Business Services501 S. Second St., Rm. 350Springfield, IL 62756217-782-6961www.cyberdriveillinois.comRemit payment in the form of a cashier220scheck, a certified check, a money order,or an Illinois attorney220s or a CPA220s checkpayable to Secretary of State. American LegalNet, Inc. www.FormsWorkFlow.com