Form Cooperative Annual Report - Washington Secretary Of State - 2013
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Cooperative Association
See attached
detailed instructions
□
Filing Fee $10.00
□
UBI Number:
Filing Fee with Expedited Service $60.00
COOPERATIVE ANNUAL REPORT
Chapter RCW 23.86
SECTION 1 (required)
:
NAME OF CORPORATION
(as currently recorded with the Office of the Secretary of State)
STATE OR COUNTRY OF INCORPORATION:
SECTION 2 (agent information required)
NAME AND ADDRESS OF THE WASHINGTON STATE REGISTERED AGENT:
Name: ____________________________________________________________________________
Physical Location Address (required):
______________________________________________________________
City _____________________________________________ WA Zip Code ____________
Mailing or Postal Address (optional):
_______________________________________________________________
City _____________________________________________ State
Zip Code _____________
CONSENT TO SERVE AS REGISTERED AGENT: (required if changes have been made.)
I consent to serve as Registered Agent in the State of Washington for the above named cooperative. I understand it will be my
responsibility to accept Service of Process on behalf of the cooperative; to forward mail to the cooperative; and to immediately notify
the Office of the Secretary of State if I resign or change the Registered Office Address.
X___________________________________________________________________________
Signature of Registered Agent
Printed Name
Date
SECTION 3 (required for Foreign Entities)
ADDRESS OF THE PRINCIPAL OFFICE:
Street Address______________________________City___
__________State
Zip__________
PO Box____________________________________City___
__________State
Zip__________
Nonprofit Cooperative – Annual Report
Washington Secretary of State
Revised 12/13
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