State of Alaska Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110806 Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Website: www.commerce.state.ak.us/occ DO NOT STAMP ABOVE THIS BOX CORP (OFFICE USE ONLY) FOREIGN CORPORATE NAME REGISTRATION OR RENEWAL APPLICATION Check if this is a renewal application FULL LEGAL NAME OF ENTITY: STATE OR TERRITORY OF DOMICLE: DATE OF INCORPORATION: PRINCIPAL OFFICE ADDRESS: Mailing Address City, State, Zip The signer acknowledges that the business is in operation. The nature of the business is: ATTACH A CERTIFICATE OF GOOD STANDING FROM THE STATE OR TERRITORY OF DOMICILE OF THIS CORPORATION. THE CERTIFICATE MUST HAVE BEEN ISSUED WITHIN THE LAST 60 DAYS. The signer must be an owner of the business; president or vice-president of the corporation; general partner of the limited partnership; member of the limited liability company; or general partner of the limited liability partnership. Signature of Applicant Printed Name of Applicant Date Contact Name and Phone Number (To resolve questions with this filing) 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 filing and the non-refundable application fee of $25.00 (in U.S. dollars) to: State of Alaska Corporations Section PO Box 110806 Juneau, AK 99811-0806 For additional information or forms please visit our web site at: www.commerce.state.ak.us/occ 08-585 (Rev. 07/2010) American LegalNet, Inc. www.FormsWorkFlow.com