Combined Statement of Conversion
Instructions
Use these instructions when completing a Statement of Conversion pursuant to § 7-90-201.7 (3) of the Colorado Revised Statutes (C.R.S.). The required form/cover sheet must be used when submitting the document for filing. Mistakes may have legal consequences: review the information provided carefully. The Colorado Secretary of State’s Office cannot provide legal advice. Questions should be addressed to your legal, business or tax advisor(s). Only provide information that is required or permitted to be included in the document. Information included in the document must be in English, typewritten or machine printed, and must state the name and address of at least one individual causing the document to be delivered for filing. In order to obtain a copy of the filed document or access additional information, including Frequently Asked Questions (FAQs), visit our Web site, www.coloradosos.gov.
Resulting Entity Information
The initial fields relate to the entity as it will exist after the conversion. These fields are as follows:
Entity Name
The Entity Name field will be pre-filled with the result of the Name Availability Search. This information cannot be changed. If this information is incorrect, click on “Previous Page” to return to the Name Availability Search page.
Form of Entity
The Form field will be pre-filled with the form of the entity selected from the Conversion page. This information cannot be changed. If the entity form is incorrect, return to the Conversion page and select the correct entity form. To return to the Conversion page, click on “Previous Page” on the Statement of Conversion page and then click on “Previous Page” on the Resulting Entity Name Availability Search page.
Jurisdiction of Entity
The Jurisdiction field will be pre-filled with “Colorado”. If Colorado is not the jurisdiction of formation for the resulting entity, return to the Conversion page and select a different form from the list that does not result in a domestic entity. To return to the Conversion page, click on “Previous Page” on the Statement of Conversion page and then click on “Previous Page” on the Resulting Entity Name Availability Search page.
Converting Entity Information
The next series of fields relate to the entity as it exists prior to the conversion. These fields are as follows:
True Name of the Converting Entity
Provide the true name of the converting entity. For legal authority, refer to § 7-90-601, C.R.S.
Form of Entity
Select the form of the converting entity from the drop-down list. If “Other” is selected, provide the form of the entity in the space provided.
Jurisdiction of Entity
Select the jurisdiction of the converting entity from the drop-down list. If “Other” is selected, provide the jurisdiction of the entity in the space provided.
Principal Office Street Address
A street address is required. Provide the street name and number, including the suite, unit or apartment number, if applicable. The city, state, and ZIP/postal code must also be provided. Any address outside of the United States must include the country and, if applicable, the province.
Example: 123 N. Main Street, Apt 101
Denver, Colorado 80202
Principal Office Mailing Address
A mailing address is optional. If the mailing address is different than the street address, or mail cannot be delivered to the street address, provide the address, including the city, state and ZIP/postal code where mail is to be delivered. Any address outside of the United States must include the country and, if applicable, the province.
Example: P.O. Box 854
Lakewood, Colorado 80228
Statement Regarding Conversion
A statement is required that the converting entity has been converted into the resulting entity pursuant to § 7-90-201.7, C.R.S.
Additional Information
Click the “Yes” button if additional information is permitted or required by law to be included in the document. After clicking on “Submit” at the bottom of the online form, the Manage Attachments page will appear. This will allow additional information to be attached as a plain text (.txt) or PDF (.pdf) document.