From Nonprofit Corporation Annual Report - Washington Secretary Of State
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Nonprofit Corporation
See attached detailed instructions
□
Filing Fee $10.00
□
Filing Fee with Expedited Service $60.00
UBI Number:
NONPROFIT CORPORATION ANNUAL REPORT
Chapter RCW 24.03
SECTION 1 (required)
:
NAME OF CORPORATION
(as currently recorded with the Office of the Secretary of State)
STATE or COUNTRY OF INCORPORATION:
SECTION 2 (agent information required)
NAME AND ADDRESS OF THE WASHINGTON STATE REGISTERED AGENT:
Name: ____________________________________________________________________________
Physical Location Address (required):
______________________________________________________________
City _____________________________________________ WA Zip Code ____________
Mailing or Postal Address (optional):
_______________________________________________________________
City _____________________________________________ WA Zip Code _____________
CONSENT TO SERVE AS REGISTERED AGENT: (required if changes have been made)
I consent to serve as Registered Agent in the State of Washington for the above named corporation. I understand it will be my
responsibility to accept Service of Process on behalf of the corporation; to forward mail to the corporation; and to immediately notify the
Office of the Secretary of State if I resign or change the Registered Office Address.
X___________________________________________________________________________
Signature of Registered Agent
Printed Name
Date
SECTION 3 (required for Foreign Entities)
ADDRESS OF THE PRINCIPAL OFFICE:
Street Address______________________________City___
__________State
Zip__________
PO Box____________________________________City___
__________State
Zip__________
Nonprofit Corporation – Annual Report
Washington Secretary of State
Revised 07/10
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