Page 2 of 2
SECTION 3
ADDRESS OF THE PRINCIPAL PLACE OF BUSINESS IN WASHINGTON STATE:
Street Address______________________________City___
__________State WA
Zip__________
PO Box____________________________________City___
__________State WA
Zip__________
SECTION 4
ADDRESS OF THE PRINCIPAL OFFICE IN ORIGINATING STATE/COUNTRY: (Foreign Entities)
Street Address______________________________City___
__________State
Zip__________
PO Box____________________________________City___
__________State
Zip__________
SECTION 5
(Required all)
OWNERSHIP OF REAL PROPERTY:
□
□
Does your company own land, buildings, or other real property in Washington? Yes
No
CONTROLLING INTEREST TRANSFER:
A controlling interest transfer is when 50 % or more of the ownership in an entity changes hands as defined
under RCW 82.45.010 (2). Has there been a transfer of stock, other financial interest change, or an option
agreement exercised during the past 12 months that resulted in a transfer of controlling interest?
□
□
Yes
No
Has an option agreement been executed in the last 12 months allowing for the future purchase or acquisition of
□
□
the entity, that, if exercised would result in a transfer of controlling interest? Yes
No
If your company owns land, buildings or other real property in Washington State, you must contact the
Washington State Department of Revenue to report a transfer of controlling interest. Failure to report the
transfer is subject to the penalty provisions of RCW 82.45.220. For more information on these questions
please call the Department of Revenue at (360) 570-3265 and choose option 1, or visit the website at
SECTION 6
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
Date
Phone
Limited Partnership – Annual Report
Washington Secretary of State
Revised 06/10