Secretary of State 
                                                                Business Programs Division 
                                                                            Business Entities 
                                                   1500 11th Street, Sacramento, CA 95814 
                                               P.O. Box 944260, Sacramento, CA 94244-2600 

                                                   Submission Cover Sheet

For faster service, file online at bizfileOnline.sos.ca.gov               . 

Instructions: 

• Complete and include this form with your paper submission. This information only will be
  used to communicate in writing about the submission, if needed. This form will be
  treated as correspondence and 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 handling fee; do not include
  a $15 handling fee when submitting documents by mail.

• Standard processing time for submissions to this office is approximately 5 business days from
  receipt. 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.

Optional Copy and Certification Fees: 

• If applicable, include optional certification fees with your submission.

• For applicable certification fee information, refer to the instructions of the specific form you are
  submitting.

Contact Person: (Please type or print legibly) 

First Name:                                      Last Name: 

Phone (optional):  

Entity Information: (Please type or print legibly) 

Name:  

Entity Number (if applicable):  

Address: 

Comments

Submission Cover Sheet (REV 03/2022)                            Clear Form  Print Form

                                                                                   GP-1A  File #  
                         State of California                                              Document #  

                         Secretary of State 

                         General Partnership 
    Statement of Partnership Authority - Conversion

           Filing Fee: $100 - $150; Certification Fee (Optional): $5.00                                         This Space For Filing Use Only 
Converted Entity Information 
1. Name of General Partnership

2. Street Address of the Chief Executive Office - Do not list a P.O. Box                               City                           State    Zip Code 

3. Street Address of the California Office, if any - Do not list a P.O. Box                            City                           State    Zip Code 
                                                                                                         CA 
4. Mailing Address of Chief Executive Office, if different from Items 2 or 3                           City                           State    Zip Code 

5.  If the converting entity is a California corporation or limited partnership,  you  must designate an initial  agent for service of process:  
    Item 5a:  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 5b: If the agent is an individual, list the agent's CA business or 
    residential street address.  Item 5c: If the agent is an individual, list the the agent's mailing address.  Do not list an address if the agent is a CA 
    registered corporate agent as the address for service of process is already on file .
    a. Name of Initial Agent For Service of Process

    b. If an individual, Street Address of Agent for Service of Process in CA - Do not list a P.O. Box City                           State    Zip Code
                                                                                                         CA 
    c. If an individual, Mailing Address of Agent for Service of Process                               City                           State    Zip Code

6.  Names of the partners authorized to execute instruments transferring real property held in the name of the partnership (attach additional pages, if 
    necessary).  
    Partner Name                                   Partner Name                                         Partner Name 

7.  Either list the full names and mailing addresses of all partners (attach additional pages, if necessary), or proceed to Item 8.   
    Name                                   Address                                                     City                           State    Zip Code

    Name                                   Address                                                     City                           State    Zip Code

8.  State the full name and mailing address of an agent appointed and maintained by the partnership who will maintain a list of the names and mailing 
    addresses of all partners. 
    Name                                   Address                                                     City                           State    Zip Code

Converting Entity Information 
9. Name of Converting Entity

10. Form of Entity                                 11. Jurisdiction                                    12. CA Secretary of State Entity Number, if any

13. 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 
14. Additional information set forth on the attached pages, if any, is incorporated herein by this reference and made part of this certificate.
15. I certify under penalty of perjury that the contents of this document are true.  I declare I am the person who executed this instrument, which execution 
    is my act and deed. 

    Signature of Authorized Person                                              Type or Print Name and Title of Authorized Person 

    Signature of Authorized Person                                              Type or Print Name and Title of Authorized Person 
GP-1A (REV 03/2022)                                                                                                   2022 California Secretary of State 
                                                                                                                      Clear Form               Print Form