"Resident Agent Appointment Form" - Washington, D.C.

Resident Agent Appointment Form is a legal document that was released by the Washington DC Department of Consumer and Regulatory Affairs - a government authority operating within Washington, D.C..

Form Details:

  • Released on December 30, 0018;
  • The latest edition currently provided by the Washington DC Department of Consumer and Regulatory Affairs;
  • Ready to use and print;
  • Easy to customize;
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  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Washington Dc Department of Consumer and Regulatory Affairs.

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Download "Resident Agent Appointment Form" - Washington, D.C.

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Resident Agent
Appointment Form
A non-resident of the District of Columbia who wishes to transact business in the District shall appoint a Resident
Agent or an Attorney-in-Fact who resides or maintains an office in the District of Columbia upon whom all fiduciary
and other process or legal notice directed to the Applicant may be served upon the appointed Resident Agent.
Applicant and named Resident Agent must complete and sign this Resident Agent Form.
I, _____________________________________________________, hereby appoint_______________________________________
of _____________________________________________________________________________________________ at (address)
_____________________________________________________________________________________________________________
Telephone _______________________________________ as my resident agent for all fiduciary and other process or
legal notice directed to the Applicant shall be served.
Signed by:
Agreed to by:
Owner/Proprietor_______________________________
Resident Agent______________________________________
Print Name_____________________________________
Print Name__________________________________________
Date___________________________________________
Date________________________________________________
DC Department of Consumer & Regulatory Affairs │ Helpline 202.442.4400
│dcra.dc.gov
____________________________________________________________________________________________
INSTRUCTIONS FOR COMPLETING THE RESIDENT AGENT APPOINTMENT FORM
Non-residents of the District of Columbia that want to conduct business in the District must appoint a Resident
Agent. Please complete the form, sign and date and attach your application for a Basic Business License.
Applicant must indicate the following:
I,
(insert name of applicant/business
owners), hereby appoint
(indicate contact/individual’s
name) of
(print
company
name) at
(print full street address in the
District), Telephone
(print contact’s telephone
number) as my
resident agent for all fiduciary and other process or legal notice directed to the Appl icant shall be served.
Signatures: both the Applicant (Owner/Proprietor) and Reside nt Agent must sign, print their names and date
the Resident Agent Appointment Form prior to attaching to application.
CRIMINAL PENALTIES FOR MAKING FALSE STATEMENTS
Any person convicted of making false statements shall be fined not more than $1,000 or imprisoned for not more than 180 days, or both. A
person commits the offense of making false statements if that person willfully makes a false statement that is in fact material, in writing,
directly or indirectly to any instrumentality of the District of Columbia government, under circumstance in which the statement
could reasonably be expected to be relied upon as true. (DC Code 22-2405)
DC INSPECTOR GENERAL HOTLINE
If you are aware of corruption, fraud, waste abuse or mismanagement involving any DC government agency, official or program, contact
the Office of the Inspector General (OIG) at the OIG Hotline, (202) 727-0267 or (800) 521-1639 (toll free). All reports are confidential and you
may remain anonymous. By law, government employees are protected from reprisals or retaliation by their employers for reporting to the OIG.
The information you provide may result in an investigation leading to administrative action, civil penalties or criminal prosecution in appropriate
cases.
NOTICE OF NON-DISCRIMINATION
In accordance with the DC Human Rights Act of 1977, as amended, DC Code section 2.1401.01 et seq., (“the Act”) the District of
Columbia does not discriminate on the basis of race, color, religion, national origin, sex, age, marital status, personal appearance, sexual
orientation, familial status, family responsibilities, matriculation, political affiliation, disabilities, source of income, or place of residents or
business. Discrimination in violation of the act will not be tolerated. Violators will be subject to disciplinary action.
1/30/2018
Resident Agent
Appointment Form
A non-resident of the District of Columbia who wishes to transact business in the District shall appoint a Resident
Agent or an Attorney-in-Fact who resides or maintains an office in the District of Columbia upon whom all fiduciary
and other process or legal notice directed to the Applicant may be served upon the appointed Resident Agent.
Applicant and named Resident Agent must complete and sign this Resident Agent Form.
I, _____________________________________________________, hereby appoint_______________________________________
of _____________________________________________________________________________________________ at (address)
_____________________________________________________________________________________________________________
Telephone _______________________________________ as my resident agent for all fiduciary and other process or
legal notice directed to the Applicant shall be served.
Signed by:
Agreed to by:
Owner/Proprietor_______________________________
Resident Agent______________________________________
Print Name_____________________________________
Print Name__________________________________________
Date___________________________________________
Date________________________________________________
DC Department of Consumer & Regulatory Affairs │ Helpline 202.442.4400
│dcra.dc.gov
____________________________________________________________________________________________
INSTRUCTIONS FOR COMPLETING THE RESIDENT AGENT APPOINTMENT FORM
Non-residents of the District of Columbia that want to conduct business in the District must appoint a Resident
Agent. Please complete the form, sign and date and attach your application for a Basic Business License.
Applicant must indicate the following:
I,
(insert name of applicant/business
owners), hereby appoint
(indicate contact/individual’s
name) of
(print
company
name) at
(print full street address in the
District), Telephone
(print contact’s telephone
number) as my
resident agent for all fiduciary and other process or legal notice directed to the Appl icant shall be served.
Signatures: both the Applicant (Owner/Proprietor) and Reside nt Agent must sign, print their names and date
the Resident Agent Appointment Form prior to attaching to application.
CRIMINAL PENALTIES FOR MAKING FALSE STATEMENTS
Any person convicted of making false statements shall be fined not more than $1,000 or imprisoned for not more than 180 days, or both. A
person commits the offense of making false statements if that person willfully makes a false statement that is in fact material, in writing,
directly or indirectly to any instrumentality of the District of Columbia government, under circumstance in which the statement
could reasonably be expected to be relied upon as true. (DC Code 22-2405)
DC INSPECTOR GENERAL HOTLINE
If you are aware of corruption, fraud, waste abuse or mismanagement involving any DC government agency, official or program, contact
the Office of the Inspector General (OIG) at the OIG Hotline, (202) 727-0267 or (800) 521-1639 (toll free). All reports are confidential and you
may remain anonymous. By law, government employees are protected from reprisals or retaliation by their employers for reporting to the OIG.
The information you provide may result in an investigation leading to administrative action, civil penalties or criminal prosecution in appropriate
cases.
NOTICE OF NON-DISCRIMINATION
In accordance with the DC Human Rights Act of 1977, as amended, DC Code section 2.1401.01 et seq., (“the Act”) the District of
Columbia does not discriminate on the basis of race, color, religion, national origin, sex, age, marital status, personal appearance, sexual
orientation, familial status, family responsibilities, matriculation, political affiliation, disabilities, source of income, or place of residents or
business. Discrimination in violation of the act will not be tolerated. Violators will be subject to disciplinary action.
1/30/2018