Form Statement Of Change For Registered Agent/office

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Statement of Change
Registered Agent or Office
See attached detailed instructions
No Fee for Standard Service
UBI Number:
Expedited Service $50.00
STATEMENT OF CHANGE FOR REGISTERED AGENT/OFFICE
Chapter 23B, 24.03, 25 RCW
SECTION 1
NAME OF ENTITY: (as currently recorded with the Office of the Secretary of State)
SECTION 2
(select the entity type that applies)
Limited Liability Company (LLC)
Profit Corporation
Non-profit Corporation
Limited Partnership (LP)
Limited Liability Partnership (LLP)
SECTION 3
(CURRENT) NAME AND ADDRESS OF THE WASHINGTON STATE REGISTERED AGENT:
Name: ____________________________________________________________________________
Physical Location Address (required):
______________________________________________________________
City _____________________________________________ WA Zip Code ____________
Mailing or Postal Address (optional):
_______________________________________________________________
City _____________________________________________ WA Zip Code _____________
Statement of Change
Washington Secretary of State
Revised 07/10

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