Form 08-4007 - Transporter License Application printable pdf download

GUI

State of Alaska

Department of Community and Economic Development

Department Use Only

Division of Occupational Licensing

P.O. Box 110806

Juneau, Alaska 99811-0806

Telephone: (907) 465-2543

Fax: (907) 465-2974

E-mail: license@dced.state.ak.us

TRANSPORTER LICENSE APPLICATION

Please submit a complete, notarized or postmaster-stamped

application and appropriate fees to the above address.

Residents:

$150.00 ($50.00 nonrefundable application fee and

$100.00 biennial license fee) or

Nonresidents:

$250.00 ($50.00 nonrefundable application fee and

$200.00 biennial license fee)

The actual company name under which you will be doing business in Alaska (d/b/a):

Transporter Business Name

Telephone Number

Mailing Address

City

State

Zip Code

Type of Organization: THIS SECTION MUST BE COMPLETED. On reverse side, please provide

complete names, date of birth, and social security numbers of owner or partners.

Sole Proprietorship

Corporation

Partnership (two or more owners, i.e.,

husband and wife)

Mode of Transportation: List each mode of transportation and the identification number, i.e., Plane

("N" no.), Boat (AK no.), Vehicle (license/serial no.).

Have you as the owner, partner, or corporate officer:

YES

1. been convicted of a state hunting, guiding, or transportation services statute or

regulation within the last five years which you were fined more than $1,000 or

imprisoned for more than five days? ...................................................................

2. been convicted of a felony within the last 10 years?...........................................

3. rights to obtain or exercise the privileges granted by a hunting, guiding, outfitting,

or transportation services license currently revoked or suspended in this state

or another state or in Canada? ...........................................................................

4. experienced or been treated for bipolar disorder, schizophrenia, paranoia, a

psychotic disorder, substance abuse, or any other mental or emotional illness

which may impair or interfere with your ability to practice as a Transporter? .....

5. been addicted to or excessively or illegally used alcohol or a controlled

substance? ..........................................................................................................

6. experienced a physical disability which may impair or interfere with your ability

to practice as a Transporter? ..............................................................................

If you answered “Yes” to questions 1-6, please explain dates and circumstances on a separate

piece of paper, and send any supporting documents that are applicable (court records, etc.)

08-4007 (Rev. 10/00)

CONTINUED ON REVERSE SIDE

Form 08-4007 - Transporter License Application

Related Articles

Related forms

Related Categories