Form 08-4372 - Request For Exception From Social Security Number Requirement - State Of Alaska
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1State of Alaska
Department of Commerce, Community and Economic Development
Division of Corporations, Business and Professional Licensing
P.O. Box 110806
Juneau, Alaska 99811-0806
Telephone: (907) 465-2550
Fax: (907) 465-2974
E-mail Address: license@alaska.gov
Website:
REQUEST FOR EXCEPTION FROM
SOCIAL SECURITY NUMBER REQUIREMENT
Alaska Statutes (AS) 08.01.060(b) and AS 08.01.100(e) require an applicant for an occupational license to
provide a United States Social Security Number. However, the Alaska Division of Corporations, Business
and Professional Licensing may, under certain circumstances, issue a license to an applicant who does not
have a Social Security Number. To apply for exception from the social security number requirement,
complete this form and mail it to the division at the address above.
1.
Do you now hold a United States Social Security Number?
Yes
No
If you answered “Yes” to question #1, you must provide the Social Security Number to the division
before you will be licensed.
2.
Have you ever held a United States Social Security Number?
Yes
No
If you answered “Yes” to question #2, submit an explanation of the status of that Social Security
Number (i.e., what occurred that removed the SSN from the Social Security Administrator’s records
and/or from being a number assigned to you?).
Explanation:
3.
What type of license are you applying for in Alaska?
I hereby certify under penalty of perjury (AS 11.56.200) that the information supplied on this form is
true and correct and I confirm that I do not have a United States Social Security Number assigned to
me. I acknowledge that if I am granted a license based on this waiver, I will be required to again
confirm my Social Security Number status at each renewal. (I also acknowledge it will be my
responsibility to request the waiver form at each renewal.)
Printed Name of Applicant
Address:
Signature of Applicant
SUBSCRIBED AND SWORN TO before me this
day of
, 20
.
Notary Public for the State of
My Commission Expires:
08-4372 (Rev. 06/03/08)
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