Free $25.00 - Alaska

State of Alaska Department of Commerce, Community, and Economic Development Division of Corporations, Business and Professional Licensing CORPORATIONS SECTION PO Box 110808 Juneau AK 99811-0808

CHANGE OF REGISTRANT INFORMATION
Alaska Registration #: Name of Mark:

Previous Information: 1. Name and Business Mailing Address of Registrant: Name: Mailing Address: City: Country: Current Information: 2. Name and Business Mailing Address of Registrant: Name: Mailing Address: City: Country: Trademark Service Mark Certification Mark Collective Mark State: Province: State: Province:

The signer must be the registrant. Date Contact Name and Phone Number (To resolve questions with this filing)

Signature

Printed Name

Title

If you have specific legal questions or concerns about this filing, you are strongly advised to consult an attorney or other professional to assist you. Mail this form and $25.00 fee to: State of Alaska Corporations Section PO Box 110808 Juneau AK 99801 For additional information or forms please visit our web site at: www.corporations.alaska.gov
08-567 (Rev. 12/06) alh 1