Non-Refundable Processing Fee: $37.00 1.The Articles/Statement of Conversion shall state:Entity Number: First: The name and entity type of the company immediately prior to the filing of the conversion: Name: Entity Type (Corp, LLC, LP, Partnership, DBA, etc.): Second: The date and state where the company was first created and, if it has changed, its jurisdiction immediately prior to its conversion; Date of formationState / JurisdictionThird: The name and entity type of the company as set forth in its converted entity filing; Name: Entity Type: State / Jurisdiction Registered Agent address or Utah mailing address for service of process if not qualified foreign entity Fourth: The future effective date of the conversion to the new entity if it is not to be effective upon the filing of the conversion; Fifth: Under penalties of perjury, I declare that the Articles/Statement of Conversion have been duly approved by the owners of the entity. Name: Signature: Title: Date: 2.Additional filing requirements: The non-refundable processing fee of $37.00 payable to the State of Utah,and application for new entity must accompany this form. No additional fee for the new application.Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. State of Utah Department of Commerce Division of Corporations & Commercial CodeArticles/Statement of Conversion American LegalNet, Inc. www.FormsWorkFlow.com