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08 -409 Rev 7/1/16 D Bus Corp Statement of Change 1 of 2 Domestic Business Corporation (AS 10. 06) • This Statement of Change form for Registered Agent s or Registered Agent Address Changes is only for Domestic Business Corporations . • 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 . COR Corporations Section State Office Building, 333 Willoughby Avenue, 9 th Floor PO Box 110806, Juneau, AK 99811-0806 Phone: (907) 465 -2550 • Fax: (907) 465 -2974 Email: corporations@alaska.gov Website: Corporations.Alaska.Gov Statement of Change 1. Important: AS 10.06.150 -.175 Per AS 10. 06.150 , each Domestic Business Corporation shall (must) continuously (without interruption) maintain in this state (Alaska) a registered agent AND a registered office (with an Alas kan physical location and an Alaskan mailing address) for the purpose of a registered agent’s statutory requirements to rec eive service of processes, notices, or demands required or permitted by law to be served upon the corporation. Failure to meet registered agent requirements could result in involuntary dissolution of the entity’s authority to transact business in the State of Alaska. — AS 10.06.633(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 16.030(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: AS 10. 06.165(a)(1) Entity Name: Alaska Entity Number: FOR DIVISION USE ONLY THE STATE ALASKA of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing 08 -409 Rev 7/1/16 D Bus Corp Statement of Change 2 of 2 4. PREVIOUS Registered Agent Information on Record with the State: AS 10.06.165(a)(2), (4) PREVIOUS Registered Agent Name: PREVIOUS Registered Agent Address es: → PHYSICAL Address: City: State: A K (mandatory ) ZIP Code: → MAILING Address: City: State: AK ( mandatory) ZIP Code: 5. NEW Registered Agent Information to be Updated with the State: AS 10.06.165(a)(3), (5) NEW Registered Agent Name: (Registered agent c annot 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 10.06.165(a)(6) The registered agent change was authorized by a resolution duly adopted by the board of directors of this corporation. Per AS 10.06.430, the domestic business corporation is to keep and make available the record of the resolution. 7. Required Signature : AS 10.06.165( a) The Statement of Change must be signed by the corporate president or vice president currently on record. Persons who sign documents filed with the commissioner that are known to the person to be fals e in material respects are guilty of a class A misdemeanor. Signature: Date: Printed Name: Title of Authorized Signer: President — or — Vice -President 08 -561 Rev 7/14 /16 Contact Information • R eturn this form with your filing • This information may be used by the Division to assist with processing your attached filings • T his form will not be filed for record , or appear online COR Corporations Section State Office Building, 333 Willoughby Avenue, 9 th Floor PO Box 110806, Juneau, AK 99811-0806 Phone: (907) 465 -2550 • Fax: (907) 465 -2974 Email: corporations@alaska.gov Website: Corporations.Alaska.Gov Contact Information Entity Information Enter your entity information as it appears on this filing. Entity Name: AK Entity #: Contact Person Whom may we contact with any questions or problems with this filing? Company: Contact: Mailing Address: Address: City: State: ZIP: Phone: Email: Document Return Address Provide an address for the return of your filed documents. Return my filings to the address provided ABOVE Return my filings to this address provided BELOW Company: Contact: Mailing Address: Address: City: State: ZIP: FOR DIVISION USE ONLY THE STATE ALASKA of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing All major credit cards are accepted. For security purposes, do not email credit card information. Include this credit card payment form with your application. Name of Applicant or Licensee: ______________________________________________________________________________________________________________ ___________ Program Type: ________________________________________________________ License Number (if applicable): ________________________________ I wish to make payment by credit card for the following (check all that apply): AMOUNT Application Fee : ________________________________________________________________ _________________________________ __________________ ________ License or R enewal Fee : _________________________________________________________________________________ ___________________ _______ Other (name change, wall certificate, fine, duplicate license, exam, etc.) : 1. ____________________________________________________________________________________ _________________________________ _____________________ _____ 2. _________________________________________________________ ___________________________________ ________________________ _ _______ ___________________ TOTAL: ___________________________ Name (as shown on credit card) : _____________________________________________________________________________________________________________ ___________ Mailing Address: _____________________________________________________________________________________________________ _____________________ _________________________ Phone Number : _ __ __________________________________________ ___________ Email (optional) : __________________________________ __________ ___________ Signature of Credit Card Holder: ________________________________________________________________________________________________ ___________________ __ 08 -4438 Rev 12/26 /18 Credit Card Payment Form (all major card s accepted) State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing PO Box 110806, Juneau, AK 99811 Phone: (907) 465 -2550 Credit Card Payment Form CREDIT CARD INFO: Your payment cannot be processed unless all fields are completed! All four fields MUST be completed! This section will be destroyed after the payment is processed. 1. Account Number : 2. Expiration Date: 3. Billing ZIP Code: 4. Security Code: FOR DIVISION USE ONLY THE STATE ALASKA of Department of Commerce, Community , and Economic Development Division of Corporations, Business and Professional Licensing 08-410 (Rev. 02/01/2012) Registered Agent Resignation Instructions REGISTERED AGENT NOTICE OF RESIGNATION All Entity Types AS 10.06.170, 10.15.030, 10.20.041, 10.25.490, 10.45.240, 10.50.063 Filing Fee: $25.00 (non-refundable) INSTRUCTIONS (Please retain for your records) Pursuant to Alaska Statutes 10.06.170, 10.15.030, 10.20.041, 10.25.490, 10.45.240, or 10.50.063 the registered agent may, at any time, resign as registered agent for any entity by submitting to this office a notice of resignation. ITEM 1 : Provide the name of the entity currently on record and the Alaska Entity Number. ITEM 2 : Provide the latest physical and mailing address of the entity. ITEM 3 : Provide the names, addresses, and titles of the most recent officials. ITEM 4 : Provide registered agent signature, printed name, and, if the registered agent is a corporation, the name of the corporation. NOTE : By signing this document, the agent acknowledges that the effective date of the resignation is thirty (30) days after the receipt of this notice, unless the entity appoints a successor agent within those thirty days. Mail the Notice of Resignation 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 ar e reviewed in the date order they are received. 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 08-410 (Rev. 02/01/2012 ) 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 W ebsite: www.commerce.state.ak.us/occ DO NOT STAMP ABOVE THIS BOX Office Use Only CORP REGISTERED AGENT NOTICE OF RESIGNATION All Entity Types AS 10.06.170, 10.15.030, 10.20.041, 10.25.490, 10.45.240, 10.50.063 $25 .00 Filing Fee (non -refundable) Pursuant to Alaska Statutes 10.06.170, 10.15.030, 10.20.041, 10.25.490, 10.45.240, or 10.50.063 , I hereby give my notice of resignation as registered agent for: ITEM 1 : Name of the Entity: Alaska Entity #: ITEM 2: The latest address of the entity’s principal office known to me is: P hysical address: Mailing address: ITEM 3: The names, addresses, and titles of the most recent officials known to me are: Title Name Mailing address City State ZIP c ode Attach an additional sheet if necessary. ITEM 4 : I understand that the effective date of the resignation is thirty (30) days after the receipt of this notice unless the entity appoints a successor agent within those thirty days . Signature of Registered Agent Printed Name Name of corp. signatory repres ents Date Mail the Notice of Resignation 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. 08-561 (Rev. 02/01/2012) 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. All major credit cards are accepted. For security purposes, do not email credit card information. Include this credit card payment form with your application. Name of Applicant or Licensee: ______________________________________________________________________________________________________________ ___________ Program Type: ________________________________________________________ License Number (if applicable): ________________________________ I wish to make payment by credit card for the following (check all that apply): AMOUNT Application Fee : ________________________________________________________________ _________________________________ __________________ ________ License or R enewal Fee : _________________________________________________________________________________ ___________________ _______ Other (name change, wall certificate, fine, duplicate license, exam, etc.) : 1. ____________________________________________________________________________________ _________________________________ _____________________ _____ 2. _________________________________________________________ ___________________________________ ________________________ _ _______ ___________________ TOTAL: ___________________________ Name (as shown on credit card) : _____________________________________________________________________________________________________________ ___________ Mailing Address: _____________________________________________________________________________________________________ _____________________ _________________________ Phone Number : _ __ __________________________________________ ___________ Email (optional) : __________________________________ __________ ___________ Signature of Credit Card Holder: ________________________________________________________________________________________________ ___________________ __ 08 -4438 Rev 12/26 /18 Credit Card Payment Form (all major card s accepted) State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing PO Box 110806, Juneau, AK 99811 Phone: (907) 465 -2550 Credit Card Payment Form CREDIT CARD INFO: Your payment cannot be processed unless all fields are completed! All four fields MUST be completed! This section will be destroyed after the payment is processed. 1. Account Number : 2. Expiration Date: 3. Billing ZIP Code: 4. Security Code: FOR DIVISION USE ONLY THE STATE ALASKA of Department of Commerce, Community , and Economic Development Division of Corporations, Business and Professional Licensing