Tennessee > Secretary Of State > Limited Liability Company
Certificate Of Conversion (Another Business Entity Into LLC) SS-4268 - Tennessee
| Certificate Of Conversion (Another Business Entity Into LLC) Form. This is a Tennessee form and can be used in Limited Liability Company Secretary Of State . |
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For Office Use Only CERTIFICATE OF CONVERSION (Another Business Entity into LLC) Corporate Filings 312 Eighth Avenue North 6th Floor, William R. Snodgrass Tower Nashville, TN 37243 Pursuant to the provisions of ยง48-249-703 of the Tennessee Revised Limited Liability Company Act, the undersigned Limited Liability Company hereby submits this certificate of conversion: 1. The name of the of the domestic limited liability company as set forth in its articles of organization is: ___________________________________________________________________________________. 2. The name of the converting other business entity immediately prior to the filing of the certificate of conversion is: ____________________________________________________________________________________. 3. The jurisdiction in which the converting other business entity was formed is ____________________ and its date of formation is ______________________ (month/day/year). 4. All required approvals of the conversion have been obtained by the other business entity. 5. If the conversion is not to be effective upon the filing of the certificate of conversion and articles of organization, then the future effective date or time of the conversion to a domestic LLC is: Date: ________________________ , _______________ Time ___________________ Signature date Signature Signer's capacity Name (typed or printed) SS-4268 (Rev. 01/06) Filing Fee $20 RDA 2458 American LegalNet, Inc. www.USCourtForms.com
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