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 
                                                          
                   AMENDED STATEMENT OF QUALIFICATION 
                          Domestic Limited Liability Partnership 
                                     AS 32.06.911 & AS 32.06.970 
 Filing Fee: $25.00 (non-refundable) 
  
 INSTRUCTIONS (Please retain for your records): 
  
 NOTICE: The Amended Statement of Qualification will not be filed if a biennial report is due. To verify this 
 information please search for the entity by going to Search Corporations Database in the Corporations Section 
 of our website at www.commerce.alaska.gov/occ. If there is a biennial report due, the report may be filed 
 online by selecting Biennial Reports on the Corporations Section page.   
  
 Refer to Alaska Statutes 32.06.911 and 32.06.970. A person authorized by this chapter to file a 
 statement may cancel amend the statement by filing an Amended Statement of Qualification.  
  
 ITEM 1: Provide the name of the entity currently on record and the Alaska Entity Number. 
  
 ITEM 2: State the reason the limited liability partnership is being amended.  
  
 ITEM 3 :The partnership may choose a deferred effective date upon which the Amended Statement of 
 Qualification will be applied in the State of Alaska.  
  
 Signatures  
 The amended statement must be filed by a partner or other person authorized by this chapter.   
  
 NOTE: 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.  
  
 Mail the Amended Statement and the non-refundable $25.00 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. 

 08-525 (Rev. 02/01/2012) Amended 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                                                                
                                                                                                                  
               AMENDED STATEMENT OF QUALIFICATION                                                    
                             Domestic Limited Liability Partnership 
                                      AS 32.06.911 & AS 32.06.970 
                                                                                      
       $25.00 Filing Fee (non-refundable) 
  
 Pursuant to Alaska Statutes 32.06.911 and 32.06.970, the undersigned partner or partnership hereby files an 
 Amended Statement of Qualification, which sets out:  
  
 ITEM 1 :Name of the Entity:                                        Alaska Entity #: 
                                                                     
 ITEM 2: Declare the amendment to the statement:  
    
 Attach an additional sheet if necessary.  
  
 ITEM 3: Effective date of amendment if deferred from date of filing (mm/dd/yyyy format): ___/___/_____ 
  
 Signatures: The statement filed by a partnership must be executed by a partner or other authorized person.  
  
 Signature of Authorized Person                             Printed Name of Partner                     Date 
  
 NOTE: 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.  
  
 Mail the Amended Statement and the non-refundable $25.00 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.  

 08-525 (Rev. 02/01/2012)    Page  of                    1 1                         

               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                                                                      
                                                                                                                         
                            CONTACT INFORMATION SHEET  

 Please return this document with your filing. This information will only be used to resolve questions with the filings 
 attached. NOTE: this form will not be filed for record or appear online. 
  
 Name of entity as it appears on filing: 
   
 To resolve questions with this filing, contact: 
  Name: 

  Email: Phone: 

  Mailing address: 

 Return documents to: 
  Name: 

  Company: 

  Mailing address: 
  
 Attach this form to your filings. Send all documents 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.  

  08-561 (Rev. 02/01/2012)                       Page  1of 1                  
  

                         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.