STATE OF ALASKA Department of Commerce, Community, and Economic Development Alcoholic Beverage Control Board Liquor License Name Change An administrative fee of $250.00 must accompany this request for the business name change. The ABC Board accepts payment in the form of personal, business or cashier’s check; money order; or VISA, Discover, MasterCard, or Diners Club. Please complete this form and return to our office with the payment. If paying by credit card, please give the phone number we can contact you at to obtain credit card information. Liquor License #: _____________ OLD Business Name: ____________________________________ Licensee Name: ____________________________________ NEW Business Name: ___________________________________ Contact Phone Number: ______________________ Licensee Signature: ___________________________________ Date: ______________________ DBA Name Change Form 08/13/12 American LegalNet, Inc. www.FormsWorkFlow.com