Certificate of Formation

Certificate of Formation - Limited Liability Company

ENTITY NAME:

PERIOD OF DURATION: Please check ONE of the following

This Company shall have a perpetual duration (default)

This Company shall have a duration of years.

This Company shall expire on

EFFECTIVE DATE: Please check ONE of the following:

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 #

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:

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.

Registered Agent Type

Individual

Entity

Office or Position

Registered Agent Street Address (required)

Country: State:

Address:

Zip: City:

Registered Agent Mailing Address (optional)

Check if mailing address is the same as street address

Country: State:

Address:

Zip: City:

Is the Registered Agent a Commercial Registered Agent? Yes No

If Yes, provide the name of the Commercial Registered Agent:

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

Principal Office Street Address (Must be a physical address; No PO Box or PMB)

Address:

Zip: City:

State: Country:

Mailing Address (optional)

Check if mailing address is the same as street address.

Address:

Zip: City:

State: Country:

Phone: Email:

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 Registered Agent’s street/mailing address.

Attention to:

Email:

Address:

City State Zip