Department of Commerce, Community, and Economic Development Division of Corporations, Business, and Professional Licensing Corporations Section PO Box 110808 Juneau AK 99811-0808 COOPERATIVE CORPORATION NOTICE OF CHANGE OFFICERS AND DIRECTORS 1. Name of Corporation: Alaska Entity #: In the event of a change of an officer or director of a corporation during the year following the filing of the biennial report, the corporation shall file notice of change amending that report before July 2nd of that year. The notice must state the name and current address of a director or officer stated in the corporation's last filed biennial report, and the name of the person replaced and the office held. 2. Prior Information: Name Address Title To list additional officers or directors, provide the above information on an 8½" x 11" sheet of paper and attach it to this form. The principal officers of a cooperative are a president, one or more vice presidents as prescribed in the bylaws, a secretary and a treasurer. The board shall elect the officers annually at the time and in the manner the bylaws provide. The offices of secretary and treasurer may be combined in one person. Each principal officer except the secretary and the treasurer, and one of the vice presidents if the bylaws provide for more than one, shall be a director of the cooperative. The manager of a cooperative may hold the office of vice president if more than one vice president is provided for in the bylaws. 3. New Information: Title Name Mailing Address (City, State, ZIP Code) 4 if Director President Vice President Secretary Treasurer Director To list additional officers or directors, provide the above information on an 8½" x 11" sheet of paper and attach it to this form. An officer of the corporation shall sign this notice. Signature of Authorized Person Title Date 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. There are no fees associated with this filing. Mail the completed filing to: State of Alaska Corporations Section PO Box 110808 Juneau, AK 99811 For additional information or forms please visit our web site at: www.corporations.alaska.gov 08-639 (Rev. 9/05) alh American LegalNet, Inc. www.USCourtForms.com