Form Statement Of Change For Registered Agent/office Page 2
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SECTION 4
(NEW) 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 _____________
CONSENT TO SERVE AS REGISTERED AGENT:
I consent to serve as Registered Agent in the State of Washington for the above named partnership. I
understand it will be my responsibility to accept Service of Process on behalf of the partnership; to forward mail
to the partnership; and to immediately notify the Office of the Secretary of State if I resign or change the
Registered Office Address.
X___________________________________________________________________________
Signature of New Registered Agent
Printed Name
Date
SECTION 5
AUTHORIZED SIGNATURE (check one)
□
Registered Agent only if change is to registered office address
□
□
□
LLC Member/Manager
Corporate Officer/Board Chairperson
General Partner
This document is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct.
X __________________________________________________________________________
Signature
Printed Name & Title
Date
Phone
Statement of Change
Washington Secretary of State
Revised 07/10
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Parent category: Legal