Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110808 Juneau AK 99811-0808 APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY For Foreign Business, Non Profit, or Cooperative Corporation Pursuant to the provisions of the Alaska Statutes, the undersigned corporation applies for an amended certificate of authority to transact business in Alaska. 1. Name of the corporation (as it is currently stated on the Certificate of Authority): Alaska Entity #: 2. Amended name of corporation (if changing the name of the corporation): 3. The assumed name elected to use in Alaska if the legal name in not available: 4. State of domicile, date of incorporation and the period of duration in the state or country of domicile: State of Domicile: Duration: 5. The purpose of the corporation and the 6-digit NAICS industry grouping code that most clearly describe the initial activities of the corporation: Purpose: NAICS Code: 6. Address of the principal office of the corporation in the state or country of domicile: Name: Mailing Address: City: State: ZIP Code: 7. Number of Authorized Shares: (Business and Cooperative Corporations) # of Authorized Shares Class Series Par Value # of Authorized Shares Class Series Par Value Number of issued shares: # of Issued Shares Class Series Par Value # of Issued Shares Class Series Par Value 08-450 (Rev. 9/05) alh -1- American LegalNet, Inc. www.USCourtForms.com 8. Other amendments to the prior Application for Certificate of Authority are as follows: The SIGNATURE and PRINTED name of the president or vice president of the corporation and its secretary or an assistant secretary is required. Signed this day of , 20 Signature of President or Vice President Printed Name Signature of Secretary or Assistant Secretary . Printed Name If the name of the entity is amended an original Certificate of Compliance, sometimes referred to as a Certificate of Good Standing or Certificate of Existence, issued by the corporation’s state of domicile is required to be filed with this application. The original certificate must not be older than 60 days. A certified copy of the articles of amendment from the state of domicile must be attached to the Application for Amended Certificate of Authority. (This does not apply if the amendment is only a name change.) If you have specific legal questions or concerns about this filing, you are strongly advised to consult an attorney or other professional to assist you. Mail the completed application, Certification from the State of Domicile, and filing fee of $25.00 (in U.S. dollars) to: State of Alaska Corporations Section PO Box 110808 Juneau AK 99801 For additional information or forms please visit our web site at: www.corporations.alaska.gov 08-450 (Rev. 9/05) alh -2- American LegalNet, Inc. www.USCourtForms.com