Free $0.00 - Alaska

Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110808 Juneau AK 99811-0808

NOTICE OF CHANGE OFFICERS, DIRECTORS OR SHAREHOLDERS
Business and Professional Corporations
Name of Corporation __________________________________________ Alaska Entity #____________ Prior Information
Name Title

New Information
List the names and mailing addresses of the officers of the entity below. Please note that this report may not be filed for record if the required information is not provided. All corporations must have a president, secretary, treasurer and at least one director. The secretary and the president cannot be the same person unless the president is 100% shareholder. The entity must also list any alien affiliates and those shareholders that hold 5% or more of the issued shares. Title
President

Name

Mailing Address

City, State Zip

if Direct or

% Shares Held

if Alien Affiliate

Vice President Secretary Treasurer Director

Please attach an additional 81/2 X 11 sheet of paper to list additional officers, directors or shareholders. This report is public information. Please do not list confidential information such as date of birth or Social Security Numbers.
AS 10.06.813. Filing Notice of Change of Officers, Directors, Five Percent Shareholders, and Alien Affiliates. (a) In the event of a change of an officer, director, or alien affiliate of a corporation during the first year of the biennial reporting period or a change in a five percent shareholder before September 30 of the first year of the biennial reporting period, the corporation shall file a notice of change amending the biennial report of the corporation before the following January 2. (b) The notice shall be filed with the commissioner and shall state the name and current mailing address of each director, officer, five percent shareholder, or alien affiliate not included in the corporation's last filed biennial report, and the name of the person replaced and the office held.

This notice shall be signed by the president or vice president of the corporation. Signature of Authorized Person Title Date

There are no fees associated with this filing. If there is a change in the registered agent of this corporation, a Registered Agent Registered Address Statement of Change form is required. The form is available on our web site at www.corporations.alaska.gov or you can call (907) 465-2530 to request the form to be mailed or faxed to you. Return this form to: State of Alaska Corporations Section PO Box 110808 Juneau, AK 99811-0808

08-636 (Rev. 12/1/05) alh