WA ST Secretary of State's Office 11/6/2019

® sfls sns CITY Oicu Office of the Secretary of State Corporations 8, Charities Division w Mailing Address: Po Box 40234 • Olympia,WA 98504-0234 0 Phone: 360-725-0378•Web Address:www.sos.wa.gov/corps E. o Expedited Services $50 e Initial$60 ❑ Re-Registration$60 plus late fee(s) o $50 late fee per year $ CHARITABLE ORGANIZATION REGISTRATION All fields required unless otherwise specified RCW 19.09 ORGANIZATION INFORMATION Registration# Organization Name: Everett Animal Shelter Fund for Animals Also known as(Names): Everett Animal Shelter,City of Everett Animal Shelter,City of Everett Fund 151 Federal EIN/Tax ID Number: (Nine digits) 91-6001248 Is this charitable organization associated with a WA State Corporation or LLC,including Nonprofit (Check one) e Yes o No If No,Continue to next question If Yes,UBI is required UBI Number: 313 000 656 Is this charitable organization associated with a Foreign Corporation or LLC,including Nonprofit(Outside of WA State) (Check one) o Yes e No If No,Continue to next section If Yes,only the Jurisdiction is required below,UBI above is optional. Jurisdiction: State/Country incorporated in.Org Name must match the name associated to the UBI# Federal Tax Exempt Status: (Check one) in Yes o No If Yes,IRS Determination letter must be attached. If organization is one of the following: Church/Church Affiliated, Government Entity, or Annual gross receipts under$5,000,then automatic exemption applies and an IRS Determination letter is not required. (Check one) ❑ 115(1) ❑170(c)(1) ❑ 501(c) Select (1-27 if not using finable form): 0 Group Exemption (if group exempt a copy of the central organization's IRS determination letter and a letter from the central organization confirming its relationship with your organization must be submitted) ❑ Church/Church Affiliated a Government Entity ❑ Annual gross receipts normally$5,000 or less 1 CH Reg Revised 12018