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

Registration# FILING CORRESPONDENCE ADDRESS This address will be sent document(s)regarding this specific filing in addition to document(s)being sent to the organization's mailing address.(Optional) Attention to: Susy Haugen Email: shaugen@everettwa.gov Address: 2930 Wetmore Avenue City Everett State WA Zip 98201 SIGNATURE(Required) By executing this document,the applicant certifies the following: • He/she is authorized to represent the above named organization. • The organization's governing body or committee has reviewed and accepted the financial information provided where applicable. • The information contained herein is accurate and true to the best of the applicant's knowledge. • He/she irrevocably appoints the Secretary of State to receive process(notice of lawsuit)in non-criminal cases against the applicant,and under the conditions set out in RCW 19.09.305; and • Neither the organization nor any of its officers,directors, and principals have been convicted of a crime involving charitable solicitations,nor been subject to a permanent injunction or administrative order under the Washington Co er Protection Act(Chapter 19.86 RCW)in the past 10 years. 5e' &der Casaio F fanklin./Mayor,City of Everett /1/b Pro ten, Signature of Applicant Printed Name/Title Date Contact phone number 425-257-6013 ALL SUBMISSIONS ARE SUBJECT TO PUBLIC REVIEW • Make checks payable to: Secretary of State • Please do not enclose a copy of the IRS Form 990, 990PF,990EZ or audited financial statements • Send regular mail to: Secretary of State• Charities Program•PO Box 40234. Olympia,WA 98504 • Send overnight/express mail to: Secretary of State• Charities Program• 801 Capitol Way S •Olympia, WA 98501 Office of the City Attorney APPROVED AS TO FORM David C.Hail.City Attorney Ali' ST: s. / c .A/.4I/1� City Clerk 6 CH Reg Revised 1.2018