Application For Certificate Of Authorization For Corporate Limited Liability Company (Llc), Or Limited Liability Partnership (Llp) Practice Form 2000

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AEL
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
For Department Use Only
BOARD OF REGISTRATION FOR ARCHITECTS, ENGINEERS
AND LAND SURVEYORS
STATE OFFICE BUILDING
333 WILLOUGHBY AVENUE, 9TH FLOOR
P.O. BOX 110806, JUNEAU, ALASKA 99811-0806
TELEPHONE: (907) 465-2540
E-mail Address: license@dced.state.ak.us
APPLICATION FOR CERTIFICATE OF AUTHORIZATION
FOR CORPORATE LIMITED LIABILITY COMPANY (LLC), OR
LIMITED LIABILITY PARTNERSHIP (LLP) PRACTICE
Fee:
$285 ($50 application fee plus $235 certification fee)
$20 wall certificate (OPTIONAL)
1. Name of Corporation, LLC, or LLP
2. Address
City
State
Zip Code
3. Name of Authorized Agent
Title
Telephone Number
4. Business Name (may be same as corporate, LLC, or LLP name)
4a. If you provide services under more than one business name, please list:
5. Name(s) of majority stockholders (attach separate sheet if necessary)
6. Field(s) of Corporate, LLC,
7. Designation of person(s) in responsible charge.
Attach separate list if necessary.
LLP Practice:
NOTE: Any future change in responsible charge must be made by submitting a certified,
notarized resolution of the board of directors within 30 days after the change. There is a
Architecture
$60 fee.
Land Surveying
Name
Field of Practice
Alaska Registration No.
Landscape Architecture
Civil Engineering
Chemical Engineering
Electrical Engineering
Mechanical Engineering
Mining Engineering
Petroleum Engineering
8. GENERAL INFORMATION QUESTIONS: Has the corporation, LLC, or LLP or any of the personnel designated in responsible
charge or any principles of the corporation, LLC, or LLP been convicted of fraud, gross negligence, incompetence, or misconduct
in the practice of architecture, engineering, land surveying, or landscape architecture, or of a U.S. or state statute excluding minor
traffic violations? If yes, please attach explanation with legal documentation.
Yes
No
9. GENERAL INFORMATION FOR CORPORATE, LLC, OR LLP APPLICANTS:
A. All information provided with this application is considered public information.
B. Must include $285 fee; amendment to bylaws; resolution of corporation’s board of directors, LLC’s managing members or
manager, or LLP’s general partners; photocopy of certificate from Alaska Division of Banking, Securities and Corporations;
evidence of corporation’s LLC’s, or LLP’s ability to provide service; professional record of person(s) in responsible charge.
C. Each business name under which corporation, LLC, or LLP provides service must be licensed through the business licensing
office.
10. I certify under penalty of perjury that the information furnished is true and correct.
Date
Signature of Authorized Agent
Title
08-610 (Rev. 12/00)

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