Domestic Limited Liability Company (AS 10.50) www.Corporations.Alaska.GovSearchCorporations Database COR Corporations Section State Office Building, 333 Willoughby Avenue, 9th Floor PO Box 110806, Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Email: corporations@alaska.gov Website:Corporations.Alaska.Gov Notice of Change of Officials 1. Important: 227 AS 10.50.765 227 AS 10.50.860-.870 2. Fee: 3. Entity Information: T HE S TATE ALASKA of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com 4. REMOVE from Record: 5. ALL Current Officials: 227 AS 10.50.155(b) 227 AS 10.50.765 (b) 227 AS 10.50.075(5) and AS 10.50.110(b) List ALL officials and their current information to be on record. BOLD fields are required. % OWNED MEMBER FULL LEGAL NAME COMPLETE MAILING ADDRESS 6. Required Signature: If signing on behalf of a member or manager which is an entity, then identify the signer222s relationship and signing authority with the member entity. For example: John Smith, President of XYZ Inc. the sole member of ABC LLC. American LegalNet, Inc. www.FormsWorkFlow.com If used, this supplement must be returned with Form 08-491 Notice of Change of Officials SUPPLEMENT 4. REMOVE from Record : 5. ALL Current Officials : 227 AS 10.50.155(b) 227 AS 10.50.765 (b) 227 AS 10.50.075(5) and AS 10.50.110(b) List ALL officials and their current information to be on record. BOLD fields are required. % OWNED MEMBER FULL LEGAL NAME COMPLETE MAILING ADDRESS AS 10.50.765(b) American LegalNet, Inc. www.FormsWorkFlow.com COR Corporations Section State Office Building, 333 Willoughby Avenue, 9th Floor PO Box 110806, Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Email: corporations@alaska.gov Website:Corporations.Alaska.Gov Contact Information Entity Information Contact Person Document Return Address ABOVE BELOW T HE S TATE ALASKA of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com All major credit cards are accepted. For security purposes, do not email credit card information. Include this credit card payment form with your application. Name of Applicant or Licensee: Program Type: License Number (if applicable): I wish to make payment by credit card for the following (check all that apply): AMOUNT Application Fee: License or Renewal Fee: Other (name change, wall certificate, fine, duplicate license, exam, etc.): 1. 2. TOTAL: Name (as shown on credit card): Mailing Address: Phone Number: Email (optional): Signature of Credit Card Holder: 08-4438 Rev 12/26/18 Credit Card Payment Form (all major cards accepted) State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing PO Box 110806, Juneau, AK 99811 Phone: (907) 465-2550 Credit Card Payment Form CREDIT CARD INFO: Your payment cannot be processed unless all fields are completed! All four fields MUST be completed! This section will be destroyed after the payment is processed. 1. Account Number : 2. Expiration Date: 3. Billing ZIP Code: 4 . Security Code : FOR DIVISION USE ONLY T HE S TATE ALASKA of Department of Commerce, Community , and Economic Development Division of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com