Professional Corporations

Contact Information

Name*

First Last

Email*

Phone*

Name of Corporation

Please provide 3 choices for the name, in order of preference, so in the event your preferred choice is not available we can proceed with your next choice. Must contain the word “Corporation”, “Company”, “Incorporated”, “Limited,” “A Professional Corporation,” or an abbreviation of one of these, such as “P.C”:

1st Choice

2nd Choice

3rd Choice

Professional Activity

Provide the name of the professional activity to be practiced by the corporation, and, separately, the 6 digit NAICS Industry Grouping Code that most clearly describes the initial activities of the company:

NAICS code

Physical Address where the professional corporation will have its office in Alaska

Street Address City State ZIP Code

Mailing Address where the professional corporation will have its office in Alaska

Street Address City State ZIP Code

Registered agent name

The registered agent of this domestic professional corporation must be an individual who is a resident of Alaska. A physical address and a mailing address in the State of Alaska must be given.

First Last

Registered Agent Physical Address

Street Address City State ZIP Code

Registered Agent Mailing Address

Street Address City State ZIP Code

Alien Affiliates

Defined in AS 10.06.990 as a person that directly or indirectly through one or more intermediaries controls, or is controlled by, or is under common control with, a corporation subject to this chapter:

1. An individual who is not a citizen or national of the United States, or who is not lawfully admitted to the United States for permanent residence, or paroled into the United States under the Immigration and Nationality Act (8 U.S.C. 1101 - 1525, as amended):

2. A person, other than an individual, that was not created or organized under the laws of the United States or of a state, or whose principal place of business is not located in any state; or

3. A person, other than an individual, that was created or organized under the laws of the United States or of a state, or whose principal place of business is located in a state, and that is controlled by a person described in (1) or (2) of this paragraph[.]”

Alien Affiliates

Name	Address	Actions

There are no Alien Affiliates.

Shareholders

List the name and addresses of all original shareholders, directors, and officers of the professional corporation. Only shareholders of the corporation can be an officer or director of the corporation. List the professional license issued by the Department of Commerce, Community, and Economic Development.

President

Name

First Last

Mailing Address

Street Address City State ZIP Code

Director

Shareholder % Owned

Professional License #

Vice President

Name

First Last

Mailing Address

Street Address City State ZIP Code

Director

Shareholder % Owned

Professional License #

Secretary

Name

First Last

Mailing Address

Street Address City State ZIP Code

Director

Shareholder % Owned

Professional License #

Treasurer

Name

First Last

Mailing Address

Street Address City State ZIP Code

Director

Shareholder % Owned

Professional License #

Incorporator

Name

First Last

Professional License #

Authorized shares

All for-profit business corporations must provide the number of authorized shares – the maximum number of shares that a corporation is legally permitted to issue. Zero (0) is not an acceptable quantity. If there is more than one class or series of authorized shares, please provide this information. Par value is the nominal value or dollar value of the original cost of a share and has no relation to market value.

Number of authorized shares

Class

Common
Preferred

Series

Par value

Number of authorized shares

Class

Common
Preferred

Series

Par value

Contact Information Sheet

Name of entity as it appears on filing

To resolve questions with this filing, contact:

Name*

First Last

Email*

Phone*

Mailing Address

Street Address City State ZIP Code

Return documents to:

Name

First Last

Company

Mailing Address

Street Address City State ZIP Code

Application Fee

Price:

Please select an additional service that you wish to have processed

Priority Request / Rush Processing + $75

Total

$0.00

NAME:*

Type your full name to sign this secure webform

Signature*

CAPACITY OF PERSON SIGNING (E.G., AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)

Authorization*

I agree

I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected applications. I understand that my application will be processed in the order in which it is received by Corporation Center, a private fee-for-service company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Corporation Center’s no refund policy.

Payment Information*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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Agree to Terms and Conditions*

I agree to the terms and conditions below: