Contact Information KANSAS SECRETARY OF STATE Kansas Secretary of State Ron Thornburgh Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-4564 kssos@kssos.org www.kssos.org Certificate of Conversion CV 53-14 All information must be completed or this document will not be accepted for filing. A general partnership, limited liability partnership (LLP), limited partnership (LP), limited liability limited partnership(LLLP), business trust/association, real estate investment trust, common-law trust, foreign limited liability company, or any other unincorporated business may convert to a Kansas LLC by certifying the following information: 1. Date and jurisdiction where the entity was formed, and, if the jurisdiction has changed, the jurisdiction immediately prior to this conversion: Do not write in this space ___________________________________________________________________________________________________________ 2. Name of the converting entity: ___________________________________________________________________________________________________________ 3. Future effective date of conversion if not effective upon filing, but not later than 90 days after the filing date: _________________ ____________ ___________ Month Day Year 4. Name of limited liability company: 5. This conversion was approved pursuant to the document, instrument, agreement or other writing governing the internal affairs of the converting entity and the conduct of its business or by applicable law. I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct. Executed on the ________ of ___________ , _____________ . Day Month Year Authorized person Instructions 1. Submit this form with the $35 filing fee. 2. Attach articles of organization for the new LLC, form DL, with the $165 filing fee. Notice: There is a $25 service fee for all returned checks. Rev. 12/08/04 amc Rev. 8/11/03 jls K.S.A. 17-7684 American LegalNet, Inc. www.USCourtForms.com