Statement Of Registered Agent
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Statement Of Registered Agent Form. This is a Washington form and can be use in Office Of The Attorney General Statewide.
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Tags: Statement Of Registered Agent, Washington Statewide, Office Of The Attorney General
Rob McKenna
ATTORNEY GENERAL OF WASHINGTON
Website: http://atg.wa.gov/Tobacco/SuppliersandManufacturers.aspx
STATEMENT OF REGISTERED AGENT
Please print or type in permanent dark ink
Sign, date, and return original to:
ATTORNEY GENERAL’S OFFICE
REVENUE DIVISION
PO BOX 40123
OLYMPIA, WA 98504-0123
TOBACCO PRODUCT MANUFACTURER:
________________________________________________________________________ hereby appoints
_____________________________________________________________________________________
as its registered agent to accept service of process on our behalf.
Signature ____________________________________________________________ Date _____________________
Print Name ___________________________________________________________
Title _________________________________________________________________
NAME AND ADDRESS OF WASHINGTON STATE REGISTERED AGENT:
Name _________________________________________________________________________________________
Street Address (Required – Must be Washington State) _____________________________________________________
PO Box (Optional – Must be in same city as street address) __________________________________________________
City _______________________________________________________________, WA Zip ___________________
Telephone _________________________________________
I consent to serve as Registered Agent in the State of Washington for the above named Tobacco Product
Manufacturer, pursuant to Laws of 2003, ch. 25. I understand it will be my responsibility to accept Service of Process
on behalf of the Tobacco Product Manufacturer; to forward mail to the Tobacco Product Manufacturer; and to
immediately notify the Office of the Attorney General if I resign or change the office address of the Registered Agent.
Signature ____________________________________________________________ Date _____________________
Print Name ___________________________________________________________
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