Form Ts-624-003 - Application For Registration As A Timeshare Company Page 2
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2APPLICANT PERSONAL DATA
1. Have you been convicted of a crime, misdemeanor or felony in this state, any other state, by the federal government,
or any other jurisdiction within the past ten years?
YES_____
NO_____
2. Is there a criminal complaint, accusation, or information presently pending against you or are you currently under
indictment in this state, any other state, by the federal government, or any other jurisdiction?
YES_____
NO_____
3. Has any professional or occupational license, certification or permit held by you, been fined, suspended, revoked,
refused or denied in this state, any other state, by the federal government or any other jurisdiction?
YES_____
NO_____
4. Have you ever had a civil court order, verdict, or judgement entered against you in any court of competent jurisdiction
in this state, any other state, the federal government, or any other jurisdiction?
YES_____
NO_____
Please attach a letter of explanation for any affirmative answers to the above questions, including charge(s), date
of conviction, civil judgement or order, county jurisdiction, state, and disposition of charges.
CONSENT TO SERVICE
RCW 64.36.035 provides that a "consent to service of process" shall be signed by an applicant promoter unless a
trustee or person with power of attorney is authorized in writing by the promoter to make such signature on the
promoter's behalf. If the signature of a person with a power of attorney or trustee is used, the filing of the signature shall
include a copy of the authorizations for the signature. If the promoter is a corporation or a general partnership,
each natural person therein, with a ten percent or greater interest or share in the promoter, shall in addition to
the promoter, be required to sign as required in this section, but may authorize a trustee or a person with
power of attorney to make the signatures.
As required for registration under the Timeshare Act, I/we, do hereby agree and consent that any lawsuit or legal
proceeding naming the operators or the undersigned as defendants, and in which the allegations of complaints therein
arise, or are alleged to have arisen, under any of the provisions of the Timeshare Act (RCW 64.36) may be commenced
or served upon the operators or the undersigned by delivery of such pleadings or proceedings to the Director of the
Department of Licensing or the Director's authorized representative at the Department of Licensing, Business and
Professions Division, Timeshare Section, PO Box 9020, Olympia, Washington 98507-9020. Such delivery shall
constitute legal service upon the operator. The Director shall, by certified mail, send to the promoter at its registration
address of record with the agency, or to its registered agent if a corporation, written notice and a copy of any such
summons and pleadings. I/we agree that it is my/our responsibility to keep said mailing address current with the
Director.
AFFIDAVIT
I, __________________________________________________, being first duly sworn, depose and say that I am the
responsible owner/promoter and that I am authorized to sign for the partnership or corporation (if applicable), and that
all timeshare salespersons hired by me to do business in this state shall be properly licensed.
I have carefully read the information herein, and pursuant to RCW 9A.72.085, I declare under penalty of perjury under
the law of the state of Washington that my answers and all statements made by me herein are true and correct.
Should I furnish any false information in this statement of record, I hereby agree that such act shall constitute cause for
the denial, suspension or revocation of the registration as a timeshare company in the state of Washington.
X
SIGNATURE OF APPLICANT
TITLE
DATE
CITY
STATE
X
SIGNATURE OF APPLICANT
TITLE
DATE
CITY
STATE
X
SIGNATURE OF APPLICANT
TITLE
DATE
CITY
STATE
X
SIGNATURE OF APPLICANT
TITLE
DATE
CITY
STATE
Upon Filing, This Application Becomes A Public Record And Is
Subject To Public Disclosure Provisions Pursuant To RCW 42.17.
TS-624-003 T/S CO. REG. (R/11/99)M/W Page 3 of 3
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