Form Nonprofit Corporation Annual Report - 2010 Page 3
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3INSTRUCTIONS – NONPROFIT ANNUAL REPORT
Please complete all sections of the Nonprofit Annual Report. USE DARK INK ONLY. For an electronic, fillable version of
this form, please visit our website at
UBI Number: Enter your existing Unified Business Identifier (UBI Number) as currently recorded with the Office of the
Secretary of State, in the box in the upper right hand corner of page 1.
Section 1: (required)
Indicate the Nonprofit Corporation name as currently registered with the Office of the Secretary of State
Section 2: (agent information is required; signature is also required when changes have been made)
All corporations must have a Registered Agent in Washington State. The Registered Agent may be an individual who is a
resident of Washington State, or a business entity registered with the Secretary of State’s office. The agent must have a
physical address in Washington State where personal service of process may be made. An alternative mailing address
may be used in addition to the physical address. The mailing address must also be in Washington State. The Registered
Agent must print his/her name or the agents name and sign the consent to serve as Registered Agent.
Section 3: (foreign entities only)
Enter the address of the Nonprofit Corporation’s principal place of business.
Section 4: (required even if no changes)
Briefly describe the nature of business being conducted by the Nonprofit Corporation.
Section 5: (required every year)
Please provide the full name and address of each officer. If necessary you may attach a sheet with additional names,
titles, and addresses. Do not include social security numbers, federal tax identification or other personal identifiers.
Section 6: (required)
Signature required. Please provide the signature, name, title, date signed, and phone number of the individual authorized
to sign the annual report.
FEES: The filing fee for Nonprofit Annual Report is $10.00. If expedited service is requested, include an additional $50.00
and write “EXPEDITE” on the outside of the envelope. Make checks or money orders payable to “Secretary of State”. (All
fees are non-refundable)
Mail completed forms and payment to:
Secretary of State
Corporations Division
801 Capitol Way S
PO Box 40234
Olympia WA 98504-0234
If you have questions, need assistance, or would like to provide feedback please visit the Corporations Division website at
or call 360-725-0377.
If your nonprofit organization is, or plans to fundraise from the public, it may also be required to
register with the Charities Program of the Secretary of State. Registration with the Charities Program
is separate from and in addition to filings required under corporate law; please visit the Charities
Program Website at to review the registration requirements and registration
forms for Charitable Organizations.
Print Form
Nonprofit Corporation – Annual Report
Washington Secretary of State
Revised 07/10
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