State of Alaska
DO NOT STAMP ABOVE THIS BOX
Division of Corporations, Business and Professional Licensing
CORP
CORPORATIONS SECTION
PO Box 110806
Juneau, AK 99811-0806
Phone: (907) 465-2550
Fax: (907) 465-2974
Website:
NOTICE OF CHANGE OF OFFICERS OR DIRECTORS
Domestic or Foreign Business and Professional Corporations
(OFFICE USE ONLY)
Name of Corporation _________________________________________ Alaska Entity #_____________
Prior Information:
Please provide only the name & title of the prior officer/director being replaced.
Name of the prior officer/director being replaced
Title
If necessary use an 8½” x 11” sheet of paper and attach it to this form.
►All corporations must have a president, secretary, treasurer and at least one director.
The president
and the secretary cannot be the same person unless the president is 100% shareholder.
The entity must also list any alien affiliates and all shareholders that hold 5% or more of the issued shares.
New Information:
Please provide only the name, address & title of the replacements for the above prior officers/directors.
Title
%
X if
Name of the replacement for
X if
Mailing Address
City, State Zip
►
Shares
Alien
(
Indicates
above prior officer/director
Director
Held
Affiliate
Required)
►President
Vice
President
►Secretary
►Treasurer
►Director
Director
Director
If necessary use an 8½” x 11” sheet of paper and attach it to this form.
This notice must be signed by the president or vice-president.
Signature of Authorized Person
Title
Date
To resolve questions with this filing:
Please be aware, this form will become public information.
Contact Name
Contact Phone Number
There are no fees associated with this filing. If there is a change in the registered agent of this corporation, a
Registered Agent Registered Address Statement of Change form is required. This, other forms and additional
information are available on our web site at
Return this form to:
State of Alaska
Corporations Section
PO Box 110806, Juneau, AK 99811-0806
08-636 (Rev. 06/29/10)