08-4678 Rev 7/1/16 E&T Statement of Change 1 of 2 Domestic Electric or Telephone Cooperatives (AS 10.25) This Statement of Change form for Registered Agents or Registered Agent Address Changes is only forDomestic Electric or Telephone Cooperatives. The Statement of Change will not be filed if the official signing this form does not match an official onrecord for this entity. To verify your entity information on record, go online to Corporations.Alaska.Gov,Search Corporations Database Standard processing time for complete and correct filings submitted to this office is approximately 10-15business days. All filings are reviewed in the date order they are received. The information you submit is a public record and will be posted on the State222s website. 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 Statement of Change 1. Important: AS 10.25.460-.480 Per AS 10.25.460, each Domestic Electric and Telephone Cooperative shall (must) continuously (without interruption) maintain in this state (Alaska) a registered agent who (per AS 10.25.460(2)) must be an individual resident of Alaska (per AS 01.10.055(a)), AND a registered office (with an Alaskan physical location and an Alaskan mailing address) for the purpose of a registered agent222s statutory requirements to receive service of processes, notices, or demands required or permitted by law to be served upon the electric or telephone cooperative. Failure to meet registered agent requirements could result in involuntary dissolution of the entity222s authority to transact business in the State of Alaska. For more registered agent information go to Corporations.Alaska.Gov, Registered Agents FAQs. 2. Fee: $25 Nonrefundable Filing Fee (CORF) 3 AAC 16.060(b) Mail this form and the non-refundable $25 filing fee in U.S. dollars to the letterhead address. Make the check or money order payable to the State of Alaska, or use the attached credit card payment form. 3. Entity Information on Record with the State: AS 10.25.470(1) Entity Name: Alaska Entity Number: 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 08-4678 Rev 7/1/16 E&T Statement of Change 2 of 2 4. PREVIOUS Registered Agent Information on Record with the State: AS 10.25.470(2), (4) PREVIOUS Registered Agent Name: PREVIOUS Registered Agent Addresses: PHYSICAL Address: City: State: AK (mandatory) ZIP Code: MAILING Address: City: State: AK (mandatory) ZIP Code: 5. NEW Registered Agent Information to be Updated with the State: AS 10.25.460(2), and AS 10.25.470(3), (5) NEW Registered Agent Name: (per AS 10.25.460(2), this must be an individual) NEW Registered Agent Addresses: PHYSICAL Address: City: State: AK (mandatory) ZIP Code: MAILING Address: City: State: AK (mandatory) ZIP Code: 6. Authorization per Alaska Statute: AS 10.25.470(7) The registered agent change was authorized by a resolution duly adopted by the board of directors of this corporation. Per AS 10.25.235, the electric or telephone cooperative is to keep and make available the record of the resolution. 7. Required Signature: AS 10.25.480 The Statement of Change must be signed by the presiding officer (i.e., corporate president or vice president) currently on record. Persons who sign documents filed with the commissioner that are known to the person to be false in material respects are guilty of a class A misdemeanor. Signature: Date: Printed Name: Title of Authorized Signer: (Must be signed by the presiding officer of the board. A director is not an authorized signer.) American LegalNet, Inc. www.FormsWorkFlow.com 08-561 Rev 7/14/16 Contact Information Return this form with your filing This information may be used by the Division to assist with processing your attached filings This form will not be filed for record, or appear online 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 Enter your entity information as it appears on this filing. Entity Name: AK Entity #: Contact Person Whom may we contact with any questions or problems with this filing? Company: Contact: Mailing Address: Address: City: State: ZIP: Phone: Email: Document Return Address Provide an address for the return of your filed documents. Return my filings to the address provided ABOVE Return my filings to this address provided BELOW Company: Contact: Mailing Address: Address: City: State: ZIP: 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 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