Secretary of State
Business Programs Division
Business Entities
1500 11th Street, Sacramento, CA 95814
P.O. Box 944260, Sacramento, CA 94244-2600
For fastest service, file online at bizfileOnline.sos.ca.gov.
• Complete and include this form with your paper submission. This form will not be made part of
the filed document.
• Make all checks or money orders payable to the Secretary of State.
• In-person submissions (excluding Statements of Information): $15 special handling fee. Do not
include a $15 special handling fee when submitting documents by mail.
• All submissions are reviewed in the date order of receipt, with online submissions given priority.
For updated processing time information, visit www.sos.ca.gov/business/be/processing-dates.
• To obtain a certified copy, include certification fees with your submission.
Contact Person (Please type or print legibly):
First Name:
Last Name:
Phone Number:
Entity Information (Please type or print legibly):
Entity Name:
Entity Number (if applicable):
Comments:
Submission Cover Sheet (REV 03/2024)
Note: All correspondence related to your submission will be
sent to the name and address on your check or money order.
Email:
Instructions:
Business Entities Submission Cover Sheet
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CONV-1A
State of California
Secretary of State
Certificate of Conversion
File #
Fee: $150.00 if a California corporation is the converting entity. $30.00 for all
other conversions.
This Space For Filing Use Only
Converted Entity Information
1. Name of Converted Entity
2. Form of Entity 3. Jurisdiction
4. Mailing Address of Principal Office of Converted Entity (Complete only if converting a California limited partnership.)
City
State
Zip Code
State
CA
If the converting entity is a California corporation, limited liability company, limited partnership or general partnership, you must designate
an agent for service of process: Item 7a: List the name of an individual or a corporation registered in CA under California Corporations Code
section 1505 that agrees to be your agent for service of process. You may not list the converted entity as the agent. Item 7b: If the agent is an
individual, list the agent's business or residential street address. Item 7c: If the agent is an individual, list the mailing address of the converted entity's
agent. Do not list an address if the agent is a California registered corporate agent as the address for service of process is already on file.
City
State
Zip Code
7.
a. Name of Agent For Service of Process
b. If an individual, Street Address of Agent for Service of Process
- Do not list a P.O. Box
c. If an individual, Mailing Address of Agent for Service of Process
City
State
Zip Code
Converting Entity Information
8. Name of Converting Entity
9. Entity Type
10. Jurisdiction
11. CA Secretary of State Entity Number, if any
12. The principal terms of the plan of conversion were approved by a vote of the number of interests or shares of each class that equaled or
exceeded the vote required. If a vote was required, the following was required for each class
:
The class and number of outstanding interests entitled to vote. AND The percentage vote required of each class.
Additional Information
13. Additional information set forth on the attached pages, if any, is incorporated herein by this reference and made part of this certificate.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct of my own knowledge. I declare
I am the person who executed this instrument, which execution is my act and deed.
Date
Signature of Authorized Person Type or Print Name and Title of Authorized Person
14.
Signature of Authorized Person Type or Print Name and Title of Authorized Person
CONV-1A (REV 12/2022)
2022 California Secretary of State
5. Street Address of Principal Office of Converted Entity - Do not list a P.O. Box (Complete only
if converting a California limited liability
company or a registered California general partnership.) City
State
6. Street Address of the California Principal Office of Conv
erted Entity, if any - Do not list a P.O. Box (Complete only if converting a registered
Zip Code
California general partnership.)
City
Zip Code
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