Fill and Sign the Fillable Online Certificate of Formation Professional Limited Liability

Certificate of Formation - Limited Liability Company Pg 1 | Revised 7.2018 This Box For Office Use Only □ Filing Fee $180 □ Filing Fee with Expedited Service $230 For name requirements review the following RCW(s): Limited Liability Company - RCW 23.95.305 (5) Certificate of Formation Limited Liability Company RCW 25.15 ENTITY NAME : PERIOD OF DURATION : P lease check ONE of th e followin g □ This Company shall have a perpetual duration (default) □ This Company shall have a duration of _ ________ years. □ This Company shall expire on _ _______________ EFFECTIVE DATE: P lea se check ONE of t h e followin g: □ Date of filing □ Specify a Date __________________ cannot be more than 90 days following received date Do you already have a UBI Number? (Check one) □ Yes □ No If Yes, provide UBI # _________________________ If No, a new UBI# will be issued to you upon successful completion of the filing. If you have previously filed with another state agency (for example, the Department of Revenue, the Department of Labor and Industries, or the Employment Security Department), you may already have a 9 digit UBI Number that you can enter above. Please do not enter the UBI Number of a Sole Proprietorship or General Partnership. If you do not have a UBI Number, please select “no” above and continue with the filing. Does the entity have a name reserved? (Check one) □ Yes □ No If Yes, provide the Name Reservation Number and Name If No, provide only the name Reservation Number: _________________ Name: ___________________________________________________________________________________________ (360) 725 - 0377 | www.sos.wa.gov/corps 801 Capitol Way S, Olympia, WA 98504 -0234 Certificate of Formation - Limited Liability Company Pg 2 | Revised 7.2018 REGISTERED AGENT: Please complete ONE type of Registered Agent below, be sure to include the name below the checked box. Then continue to provide the required street address. Mailing address if needed. Phone: ________________________ Email: _________________________________________ CONSENT TO SERVE AS REGISTERED AGENT - REQUIRED FOR ALL TYPES I hereby consent to serve as Registered Agent in the State of Washington for the named entity. I understand it will be my responsibility to accept service of process, notices, and demands on behalf of the entity; to forward mail to the entity; and to immediately notify the Office of the Secretary of State if I resign or change the Registered Office Address. __________________________________ _________________________________ ___ _________________ Signature of Registered Agent Printed Name/Title Date Country : United States State : Washington Address : ______________________________________ _________ ______________________________________ Zip : __________ City: ___________________________ Country: United States State : Washington Address : ______________________________________ _________ ______________________________________ Zip : __________ City: ___________________________ Registered Agent Mailing Address (optional) □ Check if mailing address is the same as street address Registered Agent Street Address (required) (Must be a physical address No PO Box or PMB) □ Office or Position ___________________________ List the Office or Position serves as agent. (Only if using the specific office or position as the registered agent, no matter who holds the position like: Secretary, Member or Treasurer.) □ Entity ____________________________ Name of a Non-commercial Registered Agent. (Any business not registered as a Commercial Registered Agent.) □ Individual _____________________________ First and last name of a Non-commercial Registered Agent. (Any person not registered as a Commercial Registered Agent.) Is the Registered Agent a Commercial Registered Agent? □ Yes □ No If Yes , pr ovid e t h e n am e of t he C omm er cial Register ed Agent : __________________________________ A Commercial Registered Agent is an entity or individual that is registered with the Office of the Secretary of State to receive legal documents on behalf of a corporation. A Commercial Registered Agent has the entities/individual ’s address on record with the office. A Registered Agent consent is still required for a Commercial Registered Agent located below. If No , plea se cont in ue b elow Certificate of Formation - Limited Liability Company Pg 3 | Revised 7.2018 EXECUTOR INFORMATION: Name, address, and signature required. Attach additional sheets if necessary. This record is hereby executed under penalties of perjury, and is, to the best of my knowledge, true and correct. Address: ____________________________________________________ City _____________________ State ________ Zip _________ _________ ___________________________ ______________________________ _______ _____________ Signature of Executor Printed Name/Title Date Principal Office Street Address (Must be a physical address; No PO Box or PMB) Address : _______________________________________ _________ ______________________________________ Zip: __________ City : ___________________________ State : __________ Country: _______________________ Address: _______________________________________ _________ ______________________________________ Zip: __________ City : ___________________________ State : __________ Country: _______________________ Mailing Address (optional) □ Check if mailing address is the same as street address. Phone: (optional) __________________________ Email: (optional) ___________________________________________ RETURN ADDRESS FOR THIS FILING: (Optional) This address will be sent document( s) regarding this specific filing in addition to document (s) being sent to the Reg- istered Agent ’s street/mailing address. Attention to: ___________________________________________ Email: ________________________________________________ Address : _______________________________________________________________________ City __________________________ State __________ Zip ____________