Fillable Printable Form 51577
Fillable Printable Form 51577
Form 51577
ARTICLES OF ENTITY CONVERSION
CONVERSION OF AN INDIANA NON-CORPORATION
BUSINESS ENTITY INTO AN INDIANA LIMITED LIABILITY
COMPANY
State Form 51577 (R4 / 7-16)
Approved by State Board of Accounts, 2016
SECRETARY OF STATE
BUSINESS SERVICES DIVISION
302 West Washington Street, Room E018
Indianapolis, IN 46204
Telephone: (317) 232-6576
www.sos.in.gov
INSTRUCTIONS: 1. Use 8 ½”x11 white paper for attachments.
2. Please TYPE
or PRINT in INK.
3. Please visit our office on the web at www.sos.IN.gov
4. Make check or money order payable to the Secretary of State.
5. Submit original completed paperwork and payment to: 302 West Washington Street, Room E-018, Indianapolis, IN 46204.
INFORMATION CONTAINED ON THIS PAGE IS NOT PART OF THE PUBLIC RECORD.
Name of business
E-mail address of business (SOS use only)
RETURN DOCUMENTS TO:
Name
Street address, line 1
Street address, line 2
City
State
ZIP code
Telephone number
( )
E-mail address (If different from above – SOS use only)
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Page 1 of 2
ARTICLES OF ENTITY CONVERSION
CONVERSION OF AN INDIANA NON-CORPORATION
BUSINESS ENTITY INTO AN INDIANA LIMITED LIABILITY
COMPANY
State Form 51577 (R4 / 7-16)
Approved by State Board of Accounts, 2016
IndianaCode23-1-18-3
FILINGFEE:$30.00
ARTICLESOFCONVERSION
OF
____________________________________________________________________________
(hereinafter “Non-surviving Business Entity”)
INTO
____________________________________________________________________________
(hereinafter “Surviving LLC”)
ARTICLE I: PLAN OF ENTITY CONVERSION
a. Please set forth the Plan of Conversion, containing such information as required by Indiana Code 23-1-38.5-11, attach herewith, and designate it as
“Exhibit A.”
The plan must specify the following:
A statement indicating that the type of business entity the surviving entity will be is an LLC;
The terms and conditions of the conversion;
The manner and basis of converting the interests, securities, obligations, rights to acquire interests or other securities of Non-surviving
Business Entity following its conversion into the shares of Surviving LLC; and
The full text, as in effect immediately after the consummation of the conversion, of the organic documents, if any, of Surviving LLC.
b. Please read and sign the following statement.
I hereby affirm under penalty of perjury that the plan of conversion is in accordance with the organic document of Non-surviving Business Entity and
is duly authorized as required by the laws of the State of Indiana.
Signature Printed Name Title
ARTICLE II: NAME AND TYPE OF NON-SURVIVING BUSINESS ENTITY
a. The name of Non-surviving Business Entity immediately before filing these Articles of Entity Conversion is the following:
b. Please state the type of business entity of Non-surviving Business Entity below.
ARTICLE III: NAME AND PRINCIPAL OFFICE OF SURVIVING LLC
a. The name of Surviving LLC is the following
(Please note pursuant to Indiana Code 23-18-2-8, this name must include the words “Limited Liability Company”, “L.L.C.”, or “LLC”.)
b. The address of Surviving LLC’s Principal Office is the following:
Street Address (number and street)City State ZIP code
ARTICLE IV: REGISTERED OFFICE AND AGENT OF SURVIVING LLC
Registered Agent: The name and street address of Surviving LLC’s Registered Agent and Registered Office for service of process are the following:
Name of Registered Agent
Address of Registered Office (number and street or building)
City State
Indiana
ZIP code
Page 2 of 2
ARTICLE V: DISSOLUTION OF SURVIVING LLC
Please indicate when dissolution will take place in Surviving LLC:
The latest date upon which Surviving LLC is to dissolve is ______________________________________________________, OR
Surviving LLC is perpetual until dissolution.
ARTICLE VI: MANAGEMENT OF SURVIVING LLC
Surviving LLC will be managed by: (please indicate which) The members of Surviving LLC, OR
A manager or managers
In Witness Whereof, the undersigned being an officer or other duly authorized representative of above-stated Surviving LLC
executes these Articles of Entity Conversion and verifies, subject to penalties of perjury, that the statements contained herein are
true,
this ____________________________ day of _________________________________, 20____________
Required:
By checking the box, the Signator(s) represent(s) that the registered agent named in the application has consented to the appointment of registered
agent.
Signature Printed name
Title
