Notice Of Change Of Officials (Domestic Electric Or Telephone Cooperatives) {08-4689}

08-4689 Rev E&T Coop Change of Officials 1 of 2 Domestic Electric or Telephone Cooperatives (AS 10.25) This Notice of Change of Officials form is only for Domestic Electric of Telephone Cooperatives and is usedto report changes in directors and officers information. To verify your entity and current officials 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 10-15business 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 State222s website. COR Corporations Section State Office Building, 333 Willoughby Avenue, 9th Floor PO Box 110806, Juneau, AK 99811-0806 Phone: (907) 465-2550 225 Fax: (907) 465-2974 Email: corporations@alaska.gov Website: Corporations.Alaska.Gov Notice of Change of Officials 1. Important: AS 10.25.140-.380 An Electric or Telephone Cooperative must operate as a non-profit for the mutual benefit of its members and patrons. 227 AS 10.25.380 Failure to keep the authorized signing officials on record current with this office may significantly impact the business needs of the electric or telephone cooperative. Each Domestic Electric or Telephone Cooperative must be managed by a board of not less than five (5) directors who must also be members of the cooperative. 227 AS 10.25.140 The officers are authorized by the bylaws. 227 AS 10.25.200 The Electric or Telephone Cooperative is to keep and make available records. 227 AS 10.25.235 2. Fee: $25 Nonrefundable Filing Fee (CORF) 3 AAC 16.060(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: AS 10.25.140-.200 Entity Name: Alaska Entity Number: FOR DIVISION USE ONLY T HE S TATE ALASKA of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com 08-4689 Rev E&T Coop Change of Officials 2 of 2 4. ALL Current Officials AS 10.25.080 - .200 and AS 10.06.950 The following is a complete list of ALL remaining and new officials who will be on record as a result of this filing. Electric or Telephone Cooperatives must have at least five (5) Directors, who must also be members of the cooperative. 227 AS 10.25.140 Officers authorized by the bylaws may include: President, Vice-President, Secretary, Assistant Secretary, Treasurer, and Assistant Treasurer. 227 AS 10.25.080-.200 For signing authority and future filings purposes, an Electric or Telephone Cooperative may need to have a President or Vice-President and Secretary or Assistant Secretary on record with this office. List ALL officials and their current information to be on record. BOLD fields are required. DIRECTORS (5) President Vice - President Secretary Treasurer Assistant Secretary Assistant T reasurer FULL LEGAL NAME COMPLETE MAILING ADDRESS If necessary, use the following supplement page and include all information required above in Item #4. 5. Required Signature: The Notice of Change of Officials must be signed by the presiding officer of the board (i.e., president or vice president) of the cooperative. 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. Signature: Date: Printed Name: Title of Authorized Signer: (Must be signed by the presiding officer of the board. A director is not an authorized signer.) USE ONLY TITLES PROVIDED, IF APPLICABLE PER BYLAWS American LegalNet, Inc. www.FormsWorkFlow.com 08-4689a Rev E&T Coop Change of Officials (SUPPLEMENT) If used, this supplement must be returned with Form 08-4689 Notice of Change of Officials SUPPLEMENT Entity Name: Alaska Entity Number: 4. ALL Current Officials (continued from Page 2): AS 10.25.080 - .200 and AS 10.06.950 The following is a complete list of ALL remaining and new officials who will be on record as a result of this filing. Electric or Telephone Cooperatives must have at least five (5) Directors, who must also be members of the cooperative. 227 AS 10.25.140 Officers authorized by the bylaws may include: President, Vice-President, Secretary, Assistant Secretary, Treasurer, and Assistant Treasurer. 227 AS 10.25.080-.200 For signing authority and future filings purposes, an Electric or Telephone Cooperative may need to have a President or Vice-President and Secretary or Assistant Secretary on record with this office. List ALL officials and their current information to be on record. BOLD fields are required. DIRECTORS (5) President Vice - President Secretary Treasurer Assistant Secretary Assistant Treasurer FULL LEGAL NAME COMPLETE MAILING ADDRESS USE ONLY TITLES PROVIDED, IF APPLICABLE PER BYLAWS If necessary to complete Items #4 and #5, make copies of this SUPPLEMENT page. American LegalNet, Inc. www.FormsWorkFlow.com 08-561 Rev 7/14/16 Contact Information Return this form with your filing This information may be used by the Division to assist with processing your attached filings This form will not be filed for record, or appear online COR Corporations Section State Office Building, 333 Willoughby Avenue, 9th 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 T HE S TATE ALASKA of Department of Commerce, Community and Economic Development Division of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com 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 Renewal 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 cards 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 T HE S TATE ALASKA of Department of Commerce, Community , and Economic Development Division of Corporations, Business and Professional Licensing American LegalNet, Inc. www.FormsWorkFlow.com