Fill and Sign the 08 580doc Form

08-575 (Rev. 12/07) BUSINESS NAME REGISTRATION APPLICATION Check if this is a renewal application FULL BUSINESS NAME: “Assumed Names” or “Fictitious Names” are referred to in Alaska as DBA Names. If the owner is a corporate entity, and is registering the name as a DBA name, list the name and principal office a\ ddress of the entity. NAME AND ADDRESS OF BUSINESS OWNER: Name Mailing Address City, State, Zip NAME AND ADDRESS OF THE BUSINESS: Name Mailing Address City, State, Zip ADDITIONAL PERSONS THAT HAVE AN INTEREST IN THE BUSINESS: Name Mailing Address City, State, Zip The nature of the business is: The signer acknowledges that the business is in operation. Pursuant to AS 12.70.020 for the privilege of engaging in a business in the state, a person must first obtain a business licens\ e. Business License Number The signer must be an owner of the business, or an authorized person of the DBA entity. Signature Title Date Contact Name and Phone Number (to resolve questions with this filing) Mail the completed form and the $25.00 non-refundable filing fee in U.S.\ Funds to: State of Alaska Corporations Section PO Box 110808, Juneau, AK 99811-0808 Department of Commerce, Community, and Economic Development Division of Corporations, Business, and Professional Licensing Corporations Section PO Box 110808 Juneau AK 99811-0808