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INSTRUCTIONS - CERTIFICATE OF FORMATION OF A LIMITED (Washington)

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Certificate of Formation-LLC Washington Secretary of State Revised 10.2019
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. A
fillable .pdf version of this form is available for download, or you can file online at www.sos.wa.gov/corps
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.
Expedited Service: If expedited service is requested, include an additional $50 fee and check the box indicating expedited service on
page 1.
Fees: The filing fee for the Certificate of Formation of a Limited Liability Company is $180.00
Initial Report: An initial report is due within 120 days of the effective date of this formation per RCW 23.95.255. The report may be
included with this formation at no additional fee. If the Initial Report is not submitted with this formation, a $10 filing fee will apply.
ALL FILING FEES ARE NON-REFUNDABLE. ALL DOCUMENTS ARE PUBLIC RECORD
(1) Unified Business Identifier (UBI): If the entity 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 entity may already have a 9-digit UBI number
that can be entered. Do not enter the UBI number of a Sole Proprietorship or General Partnership. If the entity does not have a UBI
number, select “No” and continue with the filing. If “No” is selected, the entity will be issued a UBI number upon successful
completion of the filing.
(2) Entity Name: In accordance with the RCW 23.95.305, a Limited Liability Company name must contain the words Limited Liability
Company, Limited Liability Co., or the abbreviation of L.L.C. or LLC. If the designation is omitted, it will default to LLC when
processed. A Limited Liability Company name must be distinguishable upon the records of the Secretary of State from any other
entity already registered with the Secretary of State’s Office.
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 “no” and enter a name to submit for review.
(3) Period of Duration: Select a period of duration. Only one selection will be accepted. Perpetual duration means “on-going” until
the entity 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 entity will be administratively dissolved as recorded in this section. If no selection is provided,
it will default to perpetual.
(4) Effective Date: Select 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 filing.
(5) Registered Agent: All entities must have a Registered Agent in Washington State 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.
Corporations & Charities Division
Physical/Overnight address:
801 Capitol Way S
Olympia, WA 98501-1226
Mailing address:
PO Box 40234
Olympia, WA 98504-0234
Tel: 360.725.0377
sos.wa.gov/corps
Certificate of Formation-LLC Washington Secretary of State Revised 10.2019
Option 1: Commercial Registered Agent is an entity or individual registered with the Office of the Secretary of State, whose
nature of business it is to receive legal documents, notice, or demand required or permitted by law to be served on behalf
of the entity. A Commercial Registered Agent has a verified address on record with the Office of the Secretary of State.
o Select “Yes” or “No.”
If “Yes,” provide the name of the Commercial Registered Agent. An address is not required.
If “No,” continue to Option 2: Noncommercial Registered Agent directions below.
Option 2: Noncommercial Registered Agent is an entity or individual who agrees to receive legal documents, notice, or
demand required or permitted by law to be served on behalf of the entity.
o Make one selection: Individual, Entity, or Office/Position, and fill out accordingly.
Individual: Write the individual’s first and last name.
Entity: Write the entity’s full name.
Office/Position: Write the office or position such as President, Secretary, or Member.
o Provide the required physical street address of the Noncommercial Registered 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 (optional). This information will be used if there are any
questions regarding the submission.
(6) Principal Office: Enter the principal office address. This is the place where the entity’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 this Filing: This section is optional. This address will be sent document(s) regarding this specific filing in
addition to the document(s) being sent to the Registered Agent's street/mailing address.
(8) Executor Information: The Executor is the person(s) forming the Limited Liability Company. List the full name and address of
each Executor. All Executors must sign the Certificate of Formation. Attach an additional list if necessary.
If you have questions, need assistance, or would like to provide feedback, visit the Corporations & Charities Division website at
www.sos.wa.gov/corps or call 360-725-0377.
Cercate of Formaon - Limited Liability Company
Pg 1 | Revised 10.2019
This Box For Office Use Only
For name requirements review the following RCW(s): RCW 23.95.305
Certificate of Formation
Limited Liability Company
RCW 23.95 and RCW 25.15
(3) 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 ________________
(4) EFFECTIVE DATE: Please check ONE of the following:
□ Date of filing □ Specify a date __________________ cannot be more than 90 days following received date
(1) 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.
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: ___________________________________________________________________________________________
□ Filing Fee $180
□ To Expedite Filing Add $50
(2) ENTITY NAME: ______________________________________________________________________________
If designation is not provided, it will be defaulted to LLC
All fields required unless otherwise specified
Physical/Overnight address Mailing Address
801 Capitol Way S PO Box 40234
Olympia, WA 98501-1226 Olympia, WA 98504-0234
Tel: 360.725.0377 www.sos.wa.gov/corps
Cercate of Formaon - Limited Liability Company
Pg 2 | Revised 10.2019
(5) 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, provide the name of the Commercial 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, please continue below
Cercate of Formaon - Limited Liability Company
Pg 3 | Revised 10.2019
(8) EXECUTOR INFORMATION:
Name, address, and signature required. Attach additional sheets if necessary.
I herby certify, under penalty of law, that the above information is accurate and complies with the filing
requirements of state law.
Name: _____________________________________________________
Address: ____________________________________________________
City _____________________ State ________ Zip _________ Country ___________________
_____________________________________ _________________________________ ____________________
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)___________________________________________
(7) 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 ______________
(6) PRINCIPAL OFFICE: *The place where the entity’s records are kept
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INSTRUCTIONS - CERTIFICATE OF FORMATION OF A LIMITED (Washington)

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Completed 9 May 2021

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