THE STATE of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing 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 ALASKA FOR DIVISION USE ONLY COR Statement of Change Foreign Limited Liability Company (AS 10.50) � This Statement of Change form for Registered Agents or Registered Agent Address Changes is only for Foreign Limited Liability Companies. � The Statement of Change will not be filed if the official signing this form does not match an official on record for this entity and/or if your entity's biennial report is not current. 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 10-15 business 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 State's website. 1. Important: AS 10.50.635-.640 Per AS 10.50.635, each Foreign Limited Liability Company shall (must) continuously (without interruption) maintain in this state (Alaska) a registered agent AND a registered office (with an Alaskan physical location and an Alaskan mailing address) for the purpose of a registered agent's statutory requirements to receive service of processes, notices, or demands required or permitted by law to be served upon the limited liability company. Failure to meet registered agent requirements could result in revocation of the entity's authority to transact business in the State of Alaska. -- AS 10.50.408(a)(2),(3) For more registered agent information go to Corporations.Alaska.Gov, Registered Agents FAQs. 2. Fee: $25 Nonrefundable Filing Fee (CORF) 3 AAC 16.065(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: Entity Name: Alaska Entity Number: AS 10.50.637(1) 08-504 Rev 7/1/16 Foreign LLC Statement of Change 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 4. PREVIOUS Registered Agent Information on Record with the State: PREVIOUS Registered Agent Name: PREVIOUS Registered Agent Addresses: AS 10.50.637(2), (4) 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: NEW Registered Agent Name: AS 10.50.637(3), (5) (Registered agent cannot be the entity listed in Item 3 on Page 1 and cannot be an LLC.) If the new Registered Agent is an entity, provide its entity number: 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 10.50.637(7) The registered agent change was authorized by the company. Per AS 10.50.860, a limited liability company is to keep and make available the record of the resolution. 7. Required Signature: AS 10.50.840 The Statement of Change must be signed by: a member (per AS 10.50.840.(a)(2)) or a manager (per AS 10.50.840(a)(1)) currently on record; or an attorney-in-fact (per AS 10.50.840(c)). 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: Printed Name: Title of Authorized Signer: Member Manager Attorney-in-fact Date: If signing on behalf of a member or manager which is an entity, then identify signer's relationship and signing authority with the member entity. For example: John Smith, President of XYZ Inc. the sole member of ABC LLC. 08-504 Rev 7/1/16 Foreign LLC Statement of Change 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com THE STATE of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing 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 ALASKA FOR DIVISION USE ONLY COR 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 Entity Information Entity Name: AK Entity #: Contact Person Company: Contact: Mailing Address: Phone: Email: Document Return Address Return my filings to the address provided ABOVE Return my filings to this address provided BELOW Company: Contact: Mailing Address: Address: City: State: ZIP: Provide an address for the return of your filed documents. Address: City: State: ZIP: Whom may we contact with any questions or problems with this filing? Enter your entity information as it appears on this filing. 08-561 Rev 7/14/16 Contact Information American LegalNet, Inc. www.FormsWorkFlow.com THE STATE of Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing 333 Willoughby Avenue, 9th Floor, Juneau, AK 99801 PO Box 110806, Juneau, AK 99811 Phone: (907) 465-2550 � Fax: (907) 465-2974 ALASKA FOR DIVISION USE ONLY CREDIT CARD PAYMENT For security purposes please do not email credit card information. Fax or mail this credit card payment form to the Division. Completion of this form is not proof of payment until the Division processes the information. If any information on this form is illegible, the form will be rejected. Name of Applicant or Licensee: Type of License: ________________________________________________________________________________________________________________________ _____________________________________________________ License Number (if applicable): ____________________________________ I wish to make payment by credit card for the following (check all that apply): Application Fee: __________________________________________________________________ ________________________________________________