Form 08-4181 - New Alaska Business License Application - 2014 Page 2
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4TOBACCO ENDORSEMENT FEE(S):
$100 PER ENDORSEMENT LOCATION (in addition to above appropriate business license fee). Tobacco
endorsements will expire on the same date as the business license to which they are attached and are
renewable with the business license. One endorsement is required for each location. Provide each
location on the Tobacco Endorsements portion of this application.
Number of Tobacco Endorsement locations:
X $100 = $
.
FEE TOTALS: Business License $ ________ + Tobacco Endorsements $ ________ = TOTAL $
_________
Make check payable to State of Alaska. Once the business license/endorsements have been issued the fees are nonrefundable.
3. OWNERSHIP INFORMATION:
Ownership Type
(Select which type of organization owns this business license.)
Sole Proprietor
(One natural individual.)
Partnership
(Two or more persons: natural individuals and/or entities. If one or more of the partners is an entity then
you must, per AS 43.70.020(d), provide the entities’ Alaska Entity Number(s) ________________________________.)
Corporation
and you must, per AS
(i.e. business, professional, religious, non-profit or cooperative corporation)
43.70.020(d), provide your Alaska Entity Number
LLC and you must, per AS 43.70.020(d), provide your Alaska Entity Number
LLP and you must, per AS 43.70.020(d), provide your Alaska Entity Number
LP and you must, per AS 43.70.020(d), provide your Alaska Entity Number
Other (describe)
(i.e. trust, tribe, village, municipality, etc.)
(For more information regarding Alaska Entity numbers go to )
Name(s) of all Owner(s):
Clearly print name of Sole Proprietor (one individual owner) OR all partner names if a Partnership OR Entity name if a Corporation,
LLC, LLP, or LP. (If necessary please use a separate page to provide the names of all owners.)
1.
____________________________________________________________________________
2.
____________________________________________________________________________
3.
____________________________________________________________________________
4.
____________________________________________________________________________
5.
____________________________________________________________________________
NAICS CODES: Effective 10/29/2014 a business license may have multiple lines of business. Choose the NAICS
4.
codes that best describes your Primary and Secondary Lines of Business activities. For more information regarding
Alaska NAICS Codes go to
NOTE: Any line of business subject to professional license, per AS 43.70.020(d), must be listed as the primary and
secondary lines of business under AS 43.70.020(a)(2). For additional information about professional licenses go to
Primary NAICS Code:
Alaska Professional License Number: ___________________
(If applicable based on the NAICS Code.)
-AND-
Secondary NAICS Code:
Alaska Professional License Number: ___________________
(If applicable based on the NAICS Code.)
5. SIGNATURE:
By signing this application I declare, under penalty of perjury, that this application is true and complete,
including any information provided in the tobacco endorsement section.
PRINT NAME:
TITLE:
PHONE: (_____) _____ - __________
(Note: Please provide appropriate title based on type of organization, such as: Sole Proprietor, Partner, or President of <owner entity name>, etc.)
SIGNATURE:
DATE:
Once the business license/endorsements have been issued the fees are nonrefundable.
To avoid processing delays do not leave any applicable area of the business license application incomplete.
IMPORTANT: If your business will sell tobacco products you must complete page three to obtain Tobacco Endorsement(s) for
each location or outlet where you will be selling tobacco products.
08-4181
Rev. 10/29/14
New BL Application page 2 of 3
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