Form Nonprofit Corporation Annual Report - 2010 Page 2
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SECTION 4 (required every year)
BRIEFLY DESCRIBE THE AFFAIRS (NATURE OF BUSINESS) THE NONPROFIT CORPORATION IS
CONDUCTING:
SECTION 5 (required every year)
NAME AND ADDRESS OF ALL CURRENT OFFICERS AND DIRECTORS:
(If necessary, attach additional names and addresses)
PRESIDENT: ____________________________________________________________________________
Address: ____________________________________________________________________________
City__________________________________ State ______ Zip Code _______ __
VICE PRESIDENT: ________________________________________________________________________
Address: ___________________________________________________________________________
City__________________________________ State ______ Zip Code __________
SECRETARY: ____________________________________________________________________________
Address: ___________________________________________________________________________
City__________________________________ State ______ Zip Code __________
TREASURER: ___________________________________________________________________________
Address: ___________________________________________________________________________
City__________________________________ State ______ Zip Code __________
DIRECTOR: _____________________________________________________________________________
Address: ___________________________________________________________________________
City__________________________________ State ______ Zip Code __________
(If necessary, attach additional names, titles and addresses)
SECTION 6 (required)
AUTHORIZED SIGNATURE
(see instructions page)
This document is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct.
X __________________________________________________________________________
Signature
Printed Name and Title
Date
Phone
Nonprofit Corporation – Annual Report
Washington Secretary of State
Revised 07/10
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