State of Alaska
Department of Community and Economic Development
Division of Banking, Securities, and Corporations
CORPORATION SECTION
PO Box 110808
Juneau AK 99811-0808
NOTICE OF CHANGE
OFFICERS, DIRECTORS OR SHAREOLDERS
Business and Professional Corporations
Name of Corporation _________________________________________ Alaska Entity #____________
Prior Information
Name
Title
New Information
Name:
Title:
% Shares:
Mailing Address:
City:
State:
ZIP Code:
Name:
Title:
% Shares:
Mailing Address:
City:
State:
ZIP Code:
Name:
Title:
% Shares:
Mailing Address:
City:
State:
ZIP Code:
Name:
Title:
% Shares:
Mailing Address:
City:
State:
ZIP Code:
To list additional officers or directors, provide the above information on a 8½" x 11" sheet of paper and attach it
to this form.
AS 10.06.813. Filing Notice of Change of Officers, Directors, Five Percent Shareholders, and Alien Affiliates.
(a) In the event of a change of an officer, director, or alien affiliate of a corporation during the first year of the biennial reporting period or a change
in a five percent shareholder before September 30 of the first year of the biennial reporting period, the corporation shall file a notice of change
amending the biennial report of the corporation before the following January 2.
(b) The notice shall be filed with the commissioner and shall state the name and current mailing address of each director, officer, five percent
shareholder, or alien affiliate not included in the corporation's last filed biennial report, and the name of the person replaced and the office held.
This notice shall be signed by the president or vice president of the corporation.
Signature of Authorized Person
Title
Date
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. The form is available on our web
site at
or you can call (907) 465-2530 to request the form to be mailed or faxed
to you.
Return this form to:
State of Alaska
Corporations Section
PO Box 110808
Juneau, AK 99811-0808
08-636 (Rev. 6/24/04) alh
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