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Fill and Sign the Crisis Loan Application Form

Fill and Sign the Crisis Loan Application Form

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State of Alaska Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing P.O. Box 110806 Juneau, Alaska 99811-0806 Telephone: (907) 465-2550 Fax: (907) 465-2974 E-mail: license@alaska.gov Website: www.commerce.state.ak.us/occ CHANGE OF NAME FORM Please complete this form showing your present and former name. This form must be NOTARIZED and submitted to this office with a copy of the court order or marriage certificate for the correction of your record within 30 days of the change of name. (Note: If the mailing address provided below is different than what we currently have on file, your record will be updated to reflect that change unless you advise otherwise.) FEE DUE: Submit a $5.00 fee made payable to the State of Alaska. am applying for or am currently licensed as I, Previous Name Alaska License No. (if applicable) a/an Occupation Current Mailing Address City State Daytime Phone No.: Email: I certify that effective Zip Code I changed my name to . Name Signature/New Name SUBSCRIBED AND SWORN to before me this day of , 20 Signature of Notary Public NOTARY SEAL City and State My Commission Expires REMINDER: ATTACH FEE AND NAME CHANGE CERTIFICATE 08-1431 (Rev. 04/20/09) .

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