STATE OF ALASKA                                                       BUS 
                        Department of Commerce, Community and Economic Development 
                        Division of Corporations, Business and Professional Licensing          
                        BUSINESS LICENSE PROGRAM                                               
                        P.O. Box 110806            
                        Juneau, Alaska 99811-0806                                              
                        Phone: (907) 465-2550                                                  
                        Website: www. commerce.alaska.gov/occ                                  
                                                                                               
                                                                                             OFFICE USE ONLY

                        BUSINESS LICENSING OWNER NAME AMENDMENT 
This form will only notify the Business Licensing Section when there is a LEGAL name change of an owner.  
Separate notices may be required to notify the Corporations Section and the Professional Licensing Section.  
A business license is not transferable or assignable.  A change of business name or a change in ownership is 
considered a separate entity and a new business license is required.   
1. Business Name: 
 
Business License #: 
 
2.  Previous Name and Mailing Address of Owner: 
             
Name: 
             
Address: 
             
                                                                                       ZIP    
City:                                              State: 
                                                                                       Code:  
 
3.  Amended Name and Mailing Address of Owner: 
             
Name: 
             
Address: 
             
                                                                                       ZIP    
City:                                              State: 
                                                                                       Code:  
By signing this amendment I declare, under penalty of perjury, that this information is true and 
complete. 
Name of person submitting amendment: 
Printed                                                                                
                                                               Title: 
Name:                                                                                  
                                                                                       
Signature:                                                     Date: 
                                                                                       
Submit this form and the $5.00 nonrefundable filing fee to: 
State of Alaska 
Business Licensing Section 
PO Box 110806 
Juneau, AK 99811-0806 
NOTE: If you are an entity and/or have a professional license you are encouraged to contact the Corporations 
Section and the Professional Licensing Section regarding any necessary notification that may need to be filed 
with these sections when there is a business owner’s legal name change. 
For more information regarding Corporations, Business and Professional Licensing, visit our website 
at www.commerce.alaska.gov/occ 
08-4104 (Rev. 01/24/13)