Form 08-410 - Application For Certificate Of Authority printable pdf download

Form 08-410 - Application For Certificate Of Authority

(FILE THE ORIGINAL APPLICATION AND AN EXACT COPY)

State of Alaska

Department of Commerce and Economic Development

Division of Banking, Securities and Corporations

Corporations Section

P.O. Box 110808, Juneau, Alaska 99811-0808

(907) 465-2530

APPLICATION FOR CERTIFICATE OF AUTHORITY

Pursuant to the provisions of Section 10.06.730 of the Alaska Corporations Code, the undersigned corporation

applies for a Certificate of Authority and, for that purpose, submits the following statement:

1. The legal name of the corporation:

2. The assumed name elected to use in Alaska (used only if the legal name is unavailable):

The legal or assumed name of the corporation must contain the word “Corporation,” “Company,”

“Incorporated,” or “Limited” or an abbreviation of these words.

3. The corporation is incorporated under the laws of

4. The date of incorporation:

and the period of duration:

5. The mailing address of the principal administrative offices of the corporation:

6. The name of the corporation’s registered agent in Alaska, and the agent’s physical address (a mailing

address must also be given if different from the physical address):

7. The purpose the corporation proposes to pursue in the transaction of business in Alaska:

SIC Code:

Primary

Secondary

OTHER

8. The names and addresses of the directors and officers (attach list if necessary):

DIRECTORS

OFFICERS

9. Attach as Exhibit A the name and address of each alien affiliate and the percentage of outstanding shares

controlled by each alien affiliate, and a specific description of the nature of the relationship between the

corporation and its alien affiliates. If none, indicate in the space provided:

No alien affiliate

Exhibit A attached

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08-410 (5/99)

Form 08-410 - Application For Certificate Of Authority