Application To Register As An Immigration Assistant - Washington Secretary Of State
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Immigration Assistant
See attached information
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There is no fee for filing this document
This Box For Office Use Only
APPLICATION TO REGISTER AS AN IMMIGRATION ASSISTANT
Chapter 19.154 RCW
SECTION 1
NAME, PHONE NUMBER AND HOME ADDRESS OF APPLICANT:
Name: ____________________________________________Phone: _______________________________
Home Address: ___________________________________________________________________________
City__________________________________ State ______ Zip Code _______ __
SECTION 2
BUSINESS NAME, BUSINESS PHONE NUMBER AND BUSINESS ADDRESS:
Name of Business:
Phone: _______________________________
Street Address______________________________City___
__________State
Zip__________
PO Box____________________________________City___
__________State
Zip__________
SECTION 5
SIGNATURE OF APPLICANT:
By signing I hereby certify that I have read and will comply with
Chapter 19.154 RCW
(Complete RCW is attached)
This document is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct.
X __________________________________________________________________________
Signature
Printed Name
Date
Phone
Please complete all sections APPLICATION TO REGISTER AS AN IMMIGRATION ASSISTANT USE DARK INK ONLY.
For an electronic, fillable version of this form, please visit our website at
Mail completed forms to:
Secretary of State
Corporation Division
801 Capitol Way S
PO Box 40234
Olympia WA 98504-0234
Immigration Assistant - Registration
Washington Secretary of State
Revised 01/09
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