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Certificate Of Conversion For Entities Converting Within Or Off The Records 700 - Ohio
| Certificate Of Conversion For Entities Converting Within Or Off The Records Form. This is a Ohio form and can be used in Mergers And Consolidations Secretary Of State . |
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Form 700 Prescribed by the: Ohio Secretary of State Central Ohio: (614) 466-3910 Toll Free: (877) SOS-FILE (767-3453) www.OhioSecretaryofState.gov Busserv@OhioSecretaryofState.gov Mail this form to one of the following: Regular Filing (non expedite) P.O. Box 788 Columbus, OH 43216 Expedite Filing (Two-business day processing time requires an additional $100.00). P.O. Box 1390 Columbus, OH 43216 Certificate for Conversion for Entities Converting Within or Off the Records of the Ohio Secretary of State Filing Fee: $125 (CHECK ONLY ONE (1) BOX) Converting Within The Records of the Ohio Secretary of State Converting Off The Records of the Ohio Secretary of State (187-VXX) Name of the converting entity Jurisdiction of Formation Charter/Registration Number The converting entity is a: (Check Only (1) One Box) Domestic Corporation (For-Profit or Nonprofit) Foreign Corporation (For-Profit or Nonprofit) Domestic Nonprofit Limited Liability Company Foreign Nonprofit Limited Liability Company Domestic For-Profit Limited Liability Company Foreign For-Profit Limited Liability Company Partnership Domestic Limited Partnership Foreign Limited Partnership Domestic Limited Liability Partnership Foreign Limited Liability Partnership Business Trust The converting entity hereby states that it has complied with all laws in the jurisdiction under which it exists and that those laws permit the conversion. Form 700 Page 1 of 5 Last Revised: 2/6/12 American LegalNet, Inc. www.FormsWorkFlow.com Name of the converted entity Jurisdiction of Formation The converted entity is a: (Check Only (1) One Box) Domestic Corporation (For-Profit or Nonprofit) Foreign Corporation (For-Profit or Nonprofit) Domestic Nonprofit Limited Liability Company Foreign Nonprofit Limited Liability Company Domestic For-Profit Limited Liability Company Foreign For-Profit Limited Liability Company Effective Date (Optional) Partnership Domestic Limited Partnership Foreign Limited Partnership Domestic Limited Liability Partnership Foreign Limited Liability Partnership Business Trust (The conversion is effective upon the filing of this certificate or on a later date specified in the certificate) Name and address of the person or entity that will provide a copy of the declaration of conversion upon written request. Name Mailing Address City State Zip Code Required information that must accompany conversion certificate if box 2 is checked If the converting entity is a domestic or foreign entity that will not be licensed in Ohio, provide the name and address of the statutory agent upon whom any process, notice or demand may be served. Name of Statutory Agent Mailing Address Ohio City State Zip Code If the agent is an individual using a P.O. Box, check this box to confirm that the agent is an Ohio resident. See instructions for additional filing requirements if (1) the conversion creates a new domestic entity, (2) the converted entity is a foreign entity that desires to transact business in Ohio; or (3) if a domestic corporation or foreign corporation licensed in Ohio is the converting entity. Form 700 Page 2 of 5 Last Revised: 2/6/12 American LegalNet, Inc. www.FormsWorkFlow.com IN WITNESS WHEREOF, the conversion is authorized on behalf of the converting entity and that each person signing the certificate of conversion is authorized to do so. Required Must be signed by an authorized representative. Signature By (if applicable) Print Name Signature By (if applicable) Print Name Signature By (if applicable) Print Name Form 700 Page 3 of 5 Last Revised: 2/6/12 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT RELEASES FROM VARIOUS GOVERNMENTAL AUTHORITIES Exact Name of Corporation If a foreign or domestic corporation licensed to transact business in Ohio is a converting entity, the certificate of conversion must be accompanied by the affidavits, receipts, certificates, or other evidence required by division (H) of section 1701.811(B)(4) of the Revised Code, unless the converted new entity is a corporation licensed in Ohio. Agency Ohio Department of Taxation Dissolution Section 4485 Northland Ridge Blvd. Columbus, Ohio 43229 Date Notified Agency Ohio Job & Family Services Status and Liability Section Data Correspondence Control Fax: 614-752-4811 Phone: 614-466-2319 Overnight: P.O. Box 182413 Columbus, OH 43218-2413 Agency Ohio Bureau of Workers' Compensation 30 W. Spring Street Columbus, OH 43215 Date Notified Treasurer The treasurer of any county in which the corporation has personal property: Regular: P.O. Box 182413 Columbus, OH 43218-2413 Date Notified Date Notified Note: This affidavit must be signed by one or more persons executing the certificate of conversion or by an officer of the corporation. Signature Title Name Mailing Address City Acknowledged before me and subscribed in my presence on Date Seal State Zip Code Commission Expires Notary Public Date Form 700 Page 4 of 5 Last Revised: 2/6/12 American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT OF PERSONAL PROPERTY State of County of SS: Name of Officer of Title of Officer Name of Corporation and that this affidavit is made in compliance with Section 1701.811(B)(4) of the Ohio Revised Code. That above-named corporation: (Check one (1) of the following) Has no personal property in any county in Ohio Is the type required to pay personal property taxes to state authorities only Has personal property in the following county (ies) and that the net assets of said corporation are sufficient to pay all personal property taxes accrued to date. Signature: Title: Acknowledged before me and subscribed in my presence on Date Seal Notary Public Expiration date of Notary Public's Commission Date Form 700 Page 5 of 5 Last Revised: 2/6/12 American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Certificate of Conversion For Entities Converting WITHIN or OFF the Records of the Ohio Secretary of State This form should be used to file a certificate of conversion to document that an entity converted "within (entities already on record with our office and remaining on record following the conversion filing)" or "off (entities already on record with our office who will no longer be on record following the conversion filing)" the records of the Ohio Secretary of State. Converting Entity Information Pursuant to Ohio Revised Code ยงยง1701.811, 1705.381, 1776.72 and 1782.4310, the certificate of conversion must set forth the name of the converting entity, the jurisdiction of formation of the co
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