STATE OF ALASKA DIVISION OF WORKERS' COMPENSATION CHANGE OF ADDRESS Pursuant to Alaska Statute 8 AAC 45.060(f), immediately upon a change of address for service, a party or a party's representative must file with the board and serve on the opposing party a written notice of the change. Until a party or the board receives written notice of a change of address, documents must be served upon a party at the party's last known address. AWCB Number: Printed Name: New Mailing Address: City, State, ZIP Code: Phone Number: Effective Date: Signature: Date: Send completed form to the Division of Workers' Compensation at one of the offices below, or by email to firstname.lastname@example.org ANCHORAGE 3301 Eagle Street, Suite 304 Anchorage, AK 99503 Tel: (907) 269-4980 Fax: (907) 269-4975 FAIRBANKS 675 Seventh Ave., Station K Fairbanks, AK 99701-4531 Tel: (907) 451-2889 Fax: (907) 451-2928 JUNEAU P.O. BOX 115512 Juneau, AK 99811 Tel: (907) 465-2790 Fax: (907) 465-2797 Form 07-6138 (Rev. 11/2015) Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com
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