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State of Alaska Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110806 Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Website: www.commerce.alaska.gov/occ STATEMENT OF CHANGE Registered Agent or Registered Agent Address Domestic Nonprofit Corporation AS 10.20.036 Filing Fee: $25.00 (non-refundable) INSTRUCTIONS (Please retain for your records): NOTICE: The Statement of Change will not be filed if a biennial report is due or the signatures do not match what the Corporations Section has on record. Please verify the following before completing the application. o o Have all current biennial reports be filed? Are the officers/directors up to date on our records? To verify this information please search for the entity by going to Search Corporations Database in the Corporations Section of our website at www.commerce.alaska.gov/occ. If there is a biennial report due, the report may be filed online by selecting Biennial Reports on the Corporations Section page. If the officers/directors have changed, but no biennial report is due, please submit a Notice of Change located in the Forms and Fees section. Pursuant to Alaska Statutes 10.20.036, the entity submits the Statement of Change for the purpose of changing its registered agent or the registered agent address in the state of Alaska. The registered agent of the corporation must be an individual who is a resident of Alaska, or a corporation (excluding LLC, LP, LLP) registered and in good standing with this office. A corporation may not act as its own registered agent. ITEM 1: Provide the name of the entity currently on record and the Alaska Entity Number. ITEM 2: Prior registered agent information. ITEM 3: New registered agent information. ITEM 4: Per AS 10.20.036(6), statement that the change was authorized by resolution of the board. ITEM 5: The Statement of Change must be signed by the corporate president or vice president currently on record. Note: 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. Mail the Statement of Change and the non-refundable filing fee $25.00 filing fee in U.S. dollars to: State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806 STANDARD PROCESSING TIME for complete and correct applications submitted to this office is approximately 10-15 business days. All applications are reviewed in the date order they are received. 08-447 (Rev. 03/12/2013) Statement of Change Instructions State of Alaska Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110806 Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Website: www.commerce.alaska.gov/occ DO NOT STAMP ABOVE THIS BOX CORP Office Use Only STATEMENT OF CHANGE Registered Agent or Registered Agent Address Domestic Nonprofit Corporation AS 10.20.036 $25.00 Filing Fee (non-refundable) To ensure a successful filing please read the instructions first and complete all sections. Failure to maintain complete registered agent information will result in the entity being Non-Compliant. Pursuant to Alaska Statutes 10.20.036, the following will apply to the registered agent on file with this office: ITEM 1: Name of the Entity: Alaska Entity #: ITEM 2: PRIOR registered agent information: Name: Physical address: City: AK Zip Code: Mailing address: City: AK Zip Code: A registered agent must be a resident of Alaska or a corporation (excluding LLC, LP and LLP) registered and in good standing with this office. A corporation may not act as its own registered agent. ITEM 3: NEW registered agent information (must include a physical and mailing address in Alaska): Name: Physical address: City: AK Zip Code: Mailing address: City: AK Zip Code: ITEM 4: Authorization per AS 10.20.036(6): The registered agent change was authorized by a resolution duly adopted by the board of directors of this nonprofit corporation. The nonprofit corporation is to keep and make available record of the resolution. ITEM 5: Required Signature: The corporate president or vice president must sign the Statement of Change. Signature of President or Vice President Printed Name of President or Vice President Date Mail the Statement of Change and the non-refundable $25.00 filing fee in U.S. dollars to: State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806 STANDARD PROCESSING TIME for complete and correct applications submitted to this office is approximately 10-15 business days. All applications are reviewed in the date order they are received. The information you submit is a public record and, once filed for record, will be posted on the State’s website. 08-447 (Rev. 03/12/2013) Page 1 of 1 State of Alaska Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110806 Juneau, AK 99811-0806 Phone: (907) 465-2550 Fax: (907) 465-2974 Website: www.commerce.alaska.gov/occ DO NOT STAMP ABOVE THIS BOX Office Use Only CORP CONTACT INFORMATION SHEET Please return this document with your filing. This information will only be used to resolve questions with the filings attached. NOTE: this form will not be filed for record or appear online. Name of entity as it appears on filing: To resolve questions with this filing, contact: Name: Email: Phone: Mailing address: Return documents to: Name: Company: Mailing address: Attach this form to your filings. Send all documents to: State of Alaska, Corporations Section, PO Box 110806, Juneau, AK 99811-0806 STANDARD PROCESSING TIME for complete and correct applications submitted to this office is approximately 10-15 business days. All applications are reviewed in the date order they are received. 08-561 (Rev. 02/01/2012) Page 1 of 1