Form 08-4161 - Residential Contractor Endorsement Application Page 2

General Information — (If you answer “yes” to any question, please explain in full on a separate sheet and provide

photocopies of any relevant legal documents.)

Within the seven years preceding the date of this application, have you been sentenced for an offense related to

(AS 08.18.025(b)(5)):

Yes

Forgery?

Conspiracy to defraud creditors?

Theft in the first or second degree?

A felony involving dishonesty?

Extortion?

I hereby certify that the information contained on this application is true and complete to the best of my

knowledge. I understand that any false or misleading information may result in failure to obtain endorsement

or subsequent revocation of my endorsement.

Signature of Applicant

Title

SUBSCRIBED AND SWORN to before me this

day of

(Notary Seal)

Notary Public

My Commission Expires:

08-4161 (Rev. 2/00)

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Parent category: Legal