T
S
HE
TATE
ALASKA
of
Department of Commerce, Community, and Economic Development
Division of Corporations, Business and Professional Licensing
State Office Building, 333 Willoughby Avenue, 9th Floor
PO Box 110806, Juneau, AK 99811-0806
Phone: (907) 465-2550
Fax: (907) 465-2974
•
Email: license@alaska.gov
Website: ProfessionalLicense.Alaska.Gov
Name Change, Address Change and/or Duplicate Professional License
I want to change my address:
No Fee
Physical Address
Mailing Address
If you have multiple professional license numbers, only the ones you list will be updated.
·
To change a business license address, browse to: BusinessLicense.Alaska.Gov
·
To change an entity address, browse to: Corporations.Alaska.Gov
You can view your updated professional license record online at: ProfessionalLicense.Alaska.Gov
Name:
License Type and Number:
New Address:
Signature:
I want a duplicate professional license:
$5.00
Your duplicate license will be mailed to your address of record, or issued in-person only to the licensee.
Name:
License Type and Number:
I want to change my name:
$5.00
You must attach a copy of the court order or marriage certificate showing your former and current name.
Previous Name:
License Type and Number:
New Name:
Notarization required for name changes only — I certify that the information on this form is true and correct:
Licensee’s Signature:
Notary Stamp
Notary Public State of:
My Commission Expires:
Subscribed and Sworn to Before me on this Day:
Notary’s Signature:
08-4291
Rev 12/22/16
Name Change, Address Change and/or Duplicate Professional License