Renewal Business Name Reservation {08-4698}

08-4698 New 11/22/16 Renewal Business Name Reservation Business Name Reservation AS 10.35 A business name reservation may only renew twice and, upon renewal, must include a statement of intent to start a business. 227 AAC 16.010(c) Name reservation is for exclusive use of the name, for a period of 120 days, by a person intending to start abusiness. 227 AS 10.35.010 & 10.35.020(a) The name must be distinguishable and cannot give the impression the business is already incorporated.227 AS 10.35.020(a) COR Corporations Section tate 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 RENEWAL Application Only Required Fee: Nonrefundable Filing Fee (CORF) 3AAC 16.010 $25.00 Business Name Reservation RENEWING: Business Name Reservation Number: (must exactly match name reservation on record) (mandatory) Owner Name: Mailing Address: Physical Address: As required by AAC 16.010(c), at renewal you must attach a statement of intent to start a business. Signature of owner or the person authorized to sign on behalf of the owner entity: This Business Name Reservation Renewal form must be signed by the Owner on record. If the Owner is an entity, then the signer must be authorized to sign on behalf of the owner entity. (For ex ample: John Smith, President of owning entity XYZ Incorporated.) Sign Print Name Title Date NOTE: If you wish to form an entity under the name you have reserved and the reservation is still active, a notice of cancellation must be sent to this office prior to formation. The notice must include the following: name of the entity, Alaska Entity Number associated with the name reservation, a statement requesting the cancellation, the signature of the applicant (or if the applicant is an entity, the signature of an authorized person from the entity). To prevent a gap between the cancellation of the Business Name Reservation and using the same name to register an entity, submit both filings together hardcopy. 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 08-561 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