Statement Of Conversion {LLC-37.10}

Print Form May 2012 Secretary of State Department of Business Services Limited Liability Division 501 S. Second St., Rm. 351 Springfield, IL 62756 217-524-8008 www.cyberdriveillinois.com Payment may be made by check payable to Secretary of State. If check is returned for any reason this filing will be void. Reset Save LLC-37.10 Illinois Limited Liability Company Act FILE # This space for use by Secretary of State. Statement of Conversion Supplement to Form LLC-5.5 SUBMITINDUPLICATE Type or Print Clearly. This space for use by Secretary of State. Filing Fee: $100 Approved: 1. Name of Entity before conversion: ____________________________________________________________________ 2. Type of entity converted to a Limited Liability Company: n Partnership n Limited Partnership 3. Limited Partnership file number, if applicable: ____________________________________________________________ 4. The agreement of conversion from a partnership or limited partnership into a Limited Liability Company has been approved by all required partners. 5. Number of votes cast by partners entitled to vote: _________________________________. 6. If the vote was less than unanimous, number or percentage of partners required by the agreement to approve conversion: _________________________________. 7. A limited partnership shall cease to exist upon the effective date of the conversion and the filing, or effective date of the Articles of Organization of the Limited Liability Company. 8. Name of Entity after conversion: ______________________________________________________________________ (name must contain Limited Liability Company, LLC or L.L.C. The undersigned affirms under penalty of perjury, having the authority to sign hereto, that this statement of conversion is to the best of my knowledge and belief, true, correct and complete. Dated: ___________________________ ___________________________________________________ Signature ___________________________________________________ Name and Title ___________________________________________________ General Partner Name (if a corporation or other entity) Printed by authority of the State of Illinois. February 2013 -- 1 -- LLC 43.3 American LegalNet, Inc. www.FormsWorkFlow.com