District of Columbia Government Corporations Division Registered Agent Combined Form. If you sign anywhere on the Registered Agent Combined Form, you agree that you understand that anyone who makes a false statement anywhere on it can be punished by criminal penalties of a fine up to $1000, imprisonment up to 180 days, or both, under DCOC § 22-2405; and the corporation's certificate of authority can be denied or revoked. RA-1. Registered Agent Written Consent. Version 2, July 2010. Use this form to appoint a Registered Agent for an entity. Choose Option A or B, but not both. There is no fee for this form. Under DC Official Code (DCOC) Titles 29 and 41, a Registered Agent (RA) must be: 1 - A bona fide resident of the District of Columbia (DC), OR 2 - A for-profit corporation, authorized by articles of incorporation or certificate of authority to act as agent. Entities may not act as their own RAs. Limited Liability Companies (LLCs) and Limited Liability Partnerships (LLPs) and Limited Partnerships (LPs) may not act as RAs. Registered Agent Addressmay never be outside the District of Columbia. Address must be physical street address, never a PO Box. A. By a District Of Columbia resident: I, a bona fide District resident, consent to act as a RA for the entity below. Name of D.C. Resident Address of Resident (address must be in DC: not a PO Box) Entity Name Signature B. By a legally authorized corporation: The authorized corporate Registered Agent in the District, by the signatures of its President/VicePresident and Secretary/Assistant Secretary, agrees to act as RA for the entity below. Name of Corporation serving as RA Address of Corporation (address must be in DC: not a PO Box) Entity Name President Vice-President Signature Secretary Assistant Secretary Signature Mail all forms and required payments to: Department of Consumer and Regulatory Affairs Corporations Division PO Box 92300 Washington, DC 20090 Phone: (202) 442-4400 Go to check dcra.dc.gov to find out which entities are required to register; search business names; get registration guidelines; search registered organizations; and download forms and documents. Just click on "Corporate Registrations." American LegalNet, Inc. www.FormsWorkFlow.com