"Statement of Conversion Converting a Domestic Entity Into a Foreign Entity - Sample" - Colorado

Statement of Conversion Converting a Domestic Entity Into a Foreign Entity - Sample is a legal document that was released by the Colorado Secretary of State - a government authority operating within Colorado.

Form Details:

  • Released on February 26, 2008;
  • The latest edition currently provided by the Colorado Secretary of State;
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Download "Statement of Conversion Converting a Domestic Entity Into a Foreign Entity - Sample" - Colorado

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Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Conversion Converting a Domestic Entity into a Foreign Entity
filed pursuant to § 7-90-201.7 (1) and § 7-90-204.5 of the Colorado Revised Statutes (C.R.S.)
1. For the converting entity, its ID number, entity name, form of entity, jurisdiction under the law of which it
is formed, and principal office address are
ID number
_________________________
(Colorado Secretary of State ID number)
Entity name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
Colorado
Principal office street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Principal office mailing address ______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
2. For the resulting entity, its true name, form of entity, jurisdiction under the law of which it is formed, and
principal address are
True name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
CONV_FOR_1
Page 1 of 3
Rev. 2/26/2008
Form must be filed electronically.
Paper forms are not accepted.
This copy is a sample and cannot be submitted for filing.
Statement of Conversion Converting a Domestic Entity into a Foreign Entity
filed pursuant to § 7-90-201.7 (1) and § 7-90-204.5 of the Colorado Revised Statutes (C.R.S.)
1. For the converting entity, its ID number, entity name, form of entity, jurisdiction under the law of which it
is formed, and principal office address are
ID number
_________________________
(Colorado Secretary of State ID number)
Entity name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
Colorado
Principal office street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Principal office mailing address ______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
2. For the resulting entity, its true name, form of entity, jurisdiction under the law of which it is formed, and
principal address are
True name
______________________________________________________
Form of entity
______________________________________________________
Jurisdiction
______________________________________________________
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________
(Province – if applicable)
(Country)
Mailing address
______________________________________________________
(leave blank if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
CONV_FOR_1
Page 1 of 3
Rev. 2/26/2008
__________________________ ____ ____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
3. The converting entity has been converted into the resulting entity pursuant to section 7-90-201.7, C.R.S.
4.
(Mark the applicable box and complete the statement. Caution: Mark only one box.)
The resulting foreign entity does not maintain a registered agent in this state and service of process
may be addressed to the entity and mailed to the principal address pursuant to section 7-90-704 (2),
C.R.S.
OR
The resulting foreign entity maintains a registered agent to accept service pursuant to section 7-90-
204.5, C.R.S. The person appointed as registered agent has consented to being so appointed. Such
registered agent’s name and address are
Name
(if an individual)
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
OR
(if an entity)
______________________________________________________
(Caution: Do not provide both an individual and an entity name.)
Street address
______________________________________________________
(Street number and name)
______________________________________________________
__________________________
CO
____________________
(City)
(State)
(ZIP Code)
Mailing address
______________________________________________________
(leave blank, if same as street address)
(Street number and name or Post Office Box information)
______________________________________________________
__________________________
CO
____________________
(City)
(State)
(ZIP Code)
5.
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains additional information as provided by law.
6.
(Caution: Leave blank if the document does not have a delayed effective date. Stating a delayed effective date has significant
legal consequences. Read instructions before entering a date.)
(If the following statement applies, adopt the statement by entering a date and, if applicable, time using the required format.)
The delayed effective date and, if applicable, time of this document are ___________________________.
(mm/dd/yyyy hour:minute am/pm)
Notice:
Causing this document to be delivered to the Secretary of State for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery, under penalties of perjury, that such document is
such individual's act and deed, or that such individual in good faith believes such document is the act and deed
of the person on whose behalf such individual is causing such document to be delivered for filing, taken in
conformity with the requirements of part 3 of article 90 of title 7, C.R.S. and, if applicable, the constituent
documents and the organic statutes, and that such individual in good faith believes the facts stated in such
document are true and such document complies with the requirements of that Part, the constituent documents,
and the organic statutes.
CONV_FOR_1
Page 2 of 3
Rev. 2/26/2008
This perjury notice applies to each individual who causes this document to be delivered to the Secretary of
State, whether or not such individual is identified in this document as one who has caused it to be delivered.
7. The true name and mailing address of the individual causing this document to be delivered for filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street number and name or Post Office Box information)
______________________________________________________
_
_
__________________________
__
____________________
(City)
(State)
(ZIP/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country)
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains the true name and mailing address of one or more additional individuals
causing the document to be delivered for filing.
Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice,
and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy
minimum legal requirements as of its revision date, compliance with applicable law, as the same may be
amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should
be addressed to the user’s legal, business or tax advisor(s).
CONV_FOR_1
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Rev. 2/26/2008
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