Cerx00740069x00660069cate of Formax00740069on - PDF document

1 Cer��cate of Forma
Cer��cate of Forma�on - Limited Liability Company Pg | Revised 12.2020 (D) REGISTERED AGENT: - FOMMERFIAI REGISTERED AGENT Please complePe ONE Pype of RegisPered AgenP NeloR and provide POe name in POe selecPed NoxB TOen conPinue Po provide POe required sPreeP addressB Mailing address is opPionalB POone: _________________________________________ Email: _________________________________________ FONSENT TO SERVE AS REGISTERED AGENT - REQUIRED FOR AII TYPES I OereNy consenP Po serve as RegisPered AgenP in POe SPaPe of WasOingPon for POe named NusinessB I undersPand iP Rill Ne my responsiNiliPy Po accepP service of process, noPices, and demands on NeOalf of POe Nusiness; Po forRard mail Po POe Nusiness; and Po immediaPely noPify POe Office of POe SecrePary of SPaPe if I resign or cOange POe RegisPered Office AddressB __________________________________ ____________________________ _________________ SignaPure of RegisPered AgenP PrinPed NameCTiPle FounPry UniPed SPaPes SPaPe WasOingPon Address _____________________________________ _____________________________________________ Zip _________ : __________________________ FounPry UniPed SPaPes SPaPe WasOingPon Address _____________________________________ _____________________________________________ Zip _________ : __________________________ RegisPered AgenP Mailing Address opPional ) FOeck if mailing address is POe same as sPreeP address RegisPered AgenP SPreeP Address required ) (MusP Ne a pOysical address; No PO Box or PMB) FOMMERFIAI REGISTERED AGENT A Fommercial RegisPered AgenP is a Nusiness or individual POaP is regisPered RiPO POe Office of POe SecrePary of SPaPe Po receive legal documenPs on NeOalf of a corporaPionB A Fommercial RegisPered AgenP address Oas Neen regisPered RiPO our officeB Is POe RegisPered AgenP a Fommercial RegisPered AgenP? (FOeck one) Yes , provide POe name of POe Fommercial RegisPered AgenP: __________________________________________ TOe Fommercial RegisPered AgenP musP sign POe consenP Po serve NeloRB , conPinue NeloR Individual ___________________________________ ____________________________________ Office or PosiPion _____________________________ Provide POe firsP and lasP name of POe individual serving as POe RegisPered AgenPB (Any person noP regisPered as a Fommercial RegisPered AgenPB) Prov

2 ide POe name of POe Nusiness serving as
ide POe name of POe Nusiness serving as POe RegisPered AgenPB (Any Nusiness noP regisPered as a Fommercial RegisPered AgenPB) lisP a Nusiness or individual s nameB Provide POe office or posiPion POaP serves as POe RegisPered AgenPB (Examples: PresidenP, SecrePary, Treasurer, or MemNer) Cer��cate of Forma�on - Limited Liability Company Pg | Revised 12.2020 (8) EXEFUTOR INFORMATION: Principal Office SPreeP Address (MusP Ne a pOysical address; No PO Box or PMB) Address ______________________________________ _____________________________________________ Zip: __________ ___________________________ SPaPe _________ FounPry ______________________ Address ______________________________________ _____________________________________________ Zip: __________ ___________________________ SPaPe _________ FounPry ______________________ Mailing Address opPional ) FOeck if mailing address is POe same as sPreeP address POone: _______________________________ _________________________________________________ (6) PRINFIPAI OFFIFE: TOe place ROere POe Nusiness s records are kepP Name, address, and signaPure requiredB APPacO addiPional sOeePs if necessaryB I OereNy cerPify, under penalPy of laR, POaP POe aNove informaPion is accuraPe and complies RiPO POe filing requiremenPs of sPaPe laRB _____________________________________________________ Address ____________________________________________________ FiPy: _____________________ SPaPe: ________ Zip: _________ FounPry: ___________________ ___________________________________ _______________________________ ___________________ SignaPure of ExecuPor PrinPed NameCTiPle DaPe (7) RETURN ADDRESS FOR THIS FIIING: (OpPional) If provided, POe confirmaPion regarding POis specific filing Rill Ne senP Po POe address NeloR, in addiPion Po POe RegisPered AgenP s addressB APPenPion: ____________________________________ ________________________________________ Address _______________________________________________________________________________________ FiPy: ________________________________________ SPaPe: _______________ Zip: ______________ Cer��cate of Forma�on - Limited Liability Company Pg | Revised 12.2020 For name requiremenPs revi

3 eR POe folloRing RFW(s): RFW 23B9DB30D
eR POe folloRing RFW(s): RFW 23B9DB30D FerPificaPe of FormaPion RFW 23B9D RFW 2DB1D (3) PERIOD OF DURATION : FOeck ONE of POe folloRing TOis Fompany sOall Oave a perpePual duraPion (defaulP) TOis Fompany sOall Oave a duraPion of _________ yearsB TOis Fompany sOall expire on ________________ (4) EFFEFTIVE DATE: ONE of POe folloRing: DaPe of filing Specify a daPe __________________ cannoP Ne more POan 90 days folloRing received daPe) (1) Do you already Oave a UBI NoB? (FOeck one) Yes ___________________ If No, a neR UBI NoB Rill Ne issued Po you upon successful complePion of POe filingB Does POe Nusiness Oave a name reserved? (FOeck one) Yes No If Yes, provide POe Name ReservaPion NumNer and Name ReservaPion NumNer: _________________ Reserved Name: __________________________________________________________________________________ Filing Fee $180 To ExpediPe Filing, Add $D0 (2) BUSINESS NAME: If designaPion is noP provided, iP Rill defaulP Po IIF All fields required unless oPOerRise specified TOis Box For Office Use Only POysicalCOvernigOP address Olympia, WA 98D01 - Tel: 360B72DB0377 Mailing Address PO Box 40234 Olympia, WA 98D04 - RRRBsosBRaBgovCcorps Certificate of Formation - LLC Washington Sec retary of State Revised 1 2 . 20 20 INSTRUCTIONS : CERTIFICATE OF FORMATION OF A LIMITED LIABILITY COMPANY RCW 23.95 and 25.15 General Instructions : Use dark ink only. Complete the entire form and enter all requested information in the fields provided. At our website www.sos.wa.gov/corps a fillable .pdf version of this form is available or you can file online at www.ccfs.sos.wa.gov Mail : Send the completed form and payment to the address listed above . Payment : Make checks or money orders payable to “Secretary of State.” Checks cannot be backdated more than 60 days from the date the check is received . Fees : The filing fee for the Certificate of Formation of a Limited Liability Company is $180.00 Expedited Service : If expedited service is requested, an additional $50 must be added to the filing fee. Check the box indicating expedited service on page one. Initial Report : An initial report is due within 120 days of the effective date of this incorporation per RCW 23.95.255 . The report may be included with this incorporation at no additional fee. If the Initial Report is not submitted with this incorporation, a $10 fili

4 ng fee will apply . AL L FILING FEE
ng fee will apply . AL L FILING FEES ARE NON - REFUNDABLE. ALL DOCUMENTS ARE PUBLIC RECORD (1 ) Unified Business Identifier (UBI) : If the business has previously filed with another state agency such as the Department of Revenue, the Department of Labor and Industries, or the Employment Security Department, the business may already have a 9 - digit UBI number that can be entered. Do not enter the UBI n umber of a Sole Proprietorship or General Partnership. If the business does not have a UBI number, select “No” and continue with the filing. If “No” is selected, the business will be issued a UBI number upon successful completion of the filing. (2) Busine ss Name : Provide the name for review. If a name has been reserved and a Name Reservation Number has been provided, enter the Number and Name in the appropriate section. If a Name Reservation has not been provided select “ N o” . In accordance with RCW 23.95.305 , a L imited L iability C ompany name must contain the words Limited Liability Company, Limited Liability Co., or the abbreviation of L.L.C. or LLC. A Limited Liability Company name must be distinguishable upon the records of the Secretary of State from any other business already registered with the Secretary of State’s Office . If the designation is omitted, it will default to LLC when processed. (3) Period of Duration : S elect a period of duration. Only one selection will be accepted. Perpetual duration means “on - going” until the business is either administratively or voluntarily dissolved. A specified date or specified number of years , may be selected . If a specified date or years is selected the business will be administratively dissolve d as recorded in this section. If no selection is provided, it will default to perpetual. (4) Effective Date : S elect the date this filing is to be effective. If “Date of Filing” is selected, the effective date will be the date the submission is completed by our office. A future effective date may be specified which may not be more than 90 days after the date of fil ing. Corporations & Charities Division Physical/Overnight address: 801 Capitol Way S Olympia, WA 9850 1 - 1226 Mailing address: PO Box 40234 Olympia, WA 98504 - 0234 Tel: 360.725.0377 sos.wa.gov/corps Certificate of Formation - LLC Washington Sec retary of State Revised 1 2 . 20 20 (5) Registered Agen t : All businesses must have a Registered Agent in Washington S

5 tate per RCW 23.95.415. Select only one
tate per RCW 23.95.415. Select only one type of agent. The Consent of the Registered Agent must be signed, regardless of the type of Registered Agent. Print the name and title of the person signing and provide the date of signature.  Commercial Registered Agent is a business or individual registered with the Office of the Secretary of State, whose n ature of business it is to receive legal documents, notices, or demands required or permitted by law to be served on behalf of the business. A Commercial Registered Agent has a verified address on record with the Office of the Secretary of State. o Select “Y es” or “No.”  If “Yes,” provide the name of the Commercial Registered Agent. An address is not required.  If “No,” continue to Noncommercial Registered Agent.  Noncommercial Registered Agent is a business or individual who agrees to receive legal documents, notice, or demand required or permitted by law to be served on behalf of the business. o Make one selection: Individual, Business, or Office/Position, and fill out accordingly.  Individual: Write the individual’s first and last name.  Business: Write the business’s full name.  Office/Position: Write the office or position such as President, Secretary, Treasurer, or Member. o Provide the required physical street address of the Noncommercial Reg istered Agent. You may also provide the mailing address if needed. Addresses must be in Washington State. o Provide a contact phone number and email address. This information will be used if there are any questions regarding the submission. (6) Principal Of fice : Enter the principal office address. This is the place where the business ’s records are kept. This address must be a physical address. A PO Box or PMB will not be accepted. The address does not need to be in Washington State. (7) Return Address for t his Filing : If provided, the confirmation regarding this specific filing will be sent to this address, in addition to the Registered Agent’s address. (8) Executor Information : Provide the name, address, and signature of the Executor (s). An Executor is the person(s) forming the Limited Liability Company. An additional list may be attached if necessary . If you have questions, need assistance, or would like to provide feedback, please visit the Corporations Division website at sos.wa.gov/corps email corps@sos.wa.gov or call 360 - 725 - 0377 . 4 4 4 4 n n 4 4