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 

                         STATEMENT OF QUALIFICATION 
                            Domestic Limited Liability Partnership 
                                                AS 32.06.911 
Filing Fee: $150.00   

INSTRUCTIONS (Please retain for your records): 
Refer to Alaska Statutes 32.06.911. If you need assistance in completing your filing, it is advised that 
you seek legal counsel. Please be aware that this filing will become public information. 
ITEM 1: Name of Corporation 
The legal name of the limited liability partnership, the name must end with “Limited Liability Partnership,” 
“L.L.P.,”  or “LLP”:The limited liability partnership name may not contain a word or phrase that indicates or 
implies that the limited liability partnership is organized for a purpose other than the purpose contained in its 
Statement of Qualification The name must be distinguishable upon the record. To search the availability of the 
legal name of the limited liability partnership in the State of Alaska, go to the Corporations Section at 
www.commerce.alaska.gov/occ and select Search Corporations Database.  

ITEM 2: Registered Agent 
The registered agent of this domestic LLP must be an individual (a natural person) who is a resident of Alaska, 
or a corporation (excluding LLC, LP, and LLP) registered and in good standing with this office. The registered 
agent is statutorily responsible for receiving and forwarding processes, notices, or demands on to the last 
known address of the entity. A LLP may not act as a registered agent. A physical address and a mailing 
address in the State of Alaska must be given.   

ITEM 3: Provide the address of the partnership’s chief executive office. 

ITEM 4: Provide the street of the office in Alaska. 

ITEM 5: This statement is required by statute and states that the partnership elects to be an LLP. 

ITEM 6: The partnership may choose a deferred effective date upon which the Statement of Qualification will 
become active in the State of Alaska.  

Signatures  
Provide the printed names and signatures of the partners (at least two) who are both natural persons of the age 
of 18 years or more.  

Mail the Statement of Qualification and the $150.00 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. To file your application online 
for immediate processing, visit our website at: www.commerce.alaska.gov/occ. 

08-524 (Rev. 8/14 7/1 )     Statement of Qualification Instructions 

ADDITIONAL RESOURCES: 
• Professional License:

For information regarding what professions require a Professional License, statutes, how to obtain a 
Professional License, and/or the expiration date if you already have a Professional License, go to the 
Professional License Section of our website at www.commerce.alaska.gov/occ.  

• Business License:

For the privilege of engaging in a business in the State of Alaska, a Business License is required for a new 
entity. For information regarding business licenses, statutes, and how to obtain a Business License, go to 
the Business License Section of our website at www.commerce.alaska.gov/occ.  

• Alaska Corporate Net Income Tax
Every corporation earning gross income from sources within the state, except for those corporations that 
are specifically exempted, must file a corporation net income tax return. Contact the Alaska Department of 
Revenue, Tax Division, PO Box 110420, Juneau, Alaska, 99811-0420, telephone number (907) 465-2320 
for more information.     

08-524 (Rev.  /814 7/1 )  Statement of Qualification Instructions 

              State of Alaska 
                                                                                     DO NOT STAMP ABOVE THIS BOX 
              Division of Corporations, Business and Professional Licensing 
                                                                                     Office Use Only       CORP 
              CORPORATIONS SECTION 
                                                                                                                  
              PO Box 110806                                                                                       
              Juneau, AK  99811-0806                                                                              
              Phone: (907) 465-2550                                                                               
              Fax: (907) 465-2974                                                                                 
                                                                                                                  
              Website: www.commerce.alaska.gov/occ                                                                
                                                                                                                  
                                  STATEMENT OF QUALIFICATION                                         
                           Domestic Limited Liability Partnership 
                                     AS 32.06.911 

      $150.00 Filing Fee                                                              

 Pursuant to Alaska Statutes 32.06.911, the undersigned partnership applies for a Certificate of Qualification 
 and, for that purpose, submits the following statement:  
  
 ITEM 1:  The legal name of the limited liability partnership, the name must end with “Limited Liability 
 Partnership,” “L.L.P.,” or “LLP”: 
    
 ITEM 2:  Registered agent name and address (must include a physical and mailing address in Alaska): 
   Full Name: 
   Physical address:                                      City:                      AK  Zip Code:  
   Mailing address:                                       City:                      AK  Zip Code:  
  
 ITEM 3 :The address of the partnership’s chief executive office (wherever located): 
   Name: 
   Physical address: 
   Mailing address: 
  
 ITEM 4 :The street address of the office in Alaska: 
   Name: 

   Physical address: 

   Mailing address: 
  
 ITEM 5: The partnership elects to be a limited liability partnership. 
  
 ITEM 6: Effective date of qualification if deferred from date of filing (mm/dd/yyyy format): ___/___/_____ 
  
 Signatures: The statement filed by a partnership must be executed by at least two partners.  
                                                                                               
 Signature of Partner                          Printed Name of Partner                              Date 
                                                                                               
 Signature of Partner                          Printed Name of Partner                                 Date 
  
 08-524 (Rev. 8/14/2017)                             Page  1of 2             

Mail the Statement of Qualification and the $150.00 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. To file 
your application online for immediate processing, visit our website at:www.commerce.alaska.gov/occ.   

08-524 (Rev. 8/14/2017)                           Page  2of 2                       

                         THE  TATE S                                                                                                          FOR DIVISION USE ONLY 
                         of 
                                                                                                                                                              
                           ALASKA 
                         Department of Commerce, Community, and Economic Development 
                         Division of Corporations, Business and Professional Licensing 
 
          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                                                                                        

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) 
  
   CREDIT CARD INFO:  Your payment cannot be processed unless all fields are completed! 
   
       1. Account Number:                                                                                       All four fields MUST 

                                                                                                                                                 be completed! 
       2. Expiration Date:                                                                                                                                    

                                                                                                                This section will be 
       3. Billing ZIP Code: 
                                                                                                                destroyed after the 
       4. Security Code:                                                                                       payment is processed.