State of Utah Department of Commerce Division of Corporations & Commercial Code Transfer of Registration of Foreign Entity Non-Refundable Processing Fee: $37.00 Use this form to transfer registration for a foreign filing entity registered to do business in Utah that merges with or converts to a foreign entity require to register to do business in Utah. Pursuant to UCA § 48-3a-909 causes this Transfer of Registration to be delivered to the Utah Division of Corporations for filing, and states as follows: 1. The Transfer of Registration shall state: Entity Number: _____________________________________ First: The name, entity type and jurisdiction of the company immediately prior to the filing of the merger or conversion Name: _______________________________________________________________________________ Entity Type (LLC, LP, LLP, LLLP): ________________________________ Jurisdiction: ________________________________ Date of Formation: ______________ Second: The name of foreign merger survivor or converted entity Name: _______________________________________________________________________________ Entity Type: ________________________________ Street and mailing address of principal office _______________________________ State / Jurisdiction ______________________________________________________________________________________ Third: Utah Registered Agent Name: _______________________________________________________________________________ An address must be listed if you have a non-commercial registered agent. Address of the Registered Agent: ________________________________________________________ Utah Street Address Required, PO Boxes can be listed after the Street Address City: _______________________________________________________ State: UT Zip: ____________ Fourth: Under penalties of perjury, I declare that the Transfer of Registration has been duly approved by the owners of the entity. Name: ______________________________ Title: _______________________________ Signature: ___________________________ Date: _______________________________ 2. Additional filing requirements: The non-refundable processing fee of $37.00 payable to the State of Utah, and application for converted 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. Mailing/Faxing Information: www.corporations.utah.gov/contactus.html Division's Website: www.corporations.utah.gov 04/17 American LegalNet, Inc. www.FormsWorkFlow.com