certified public accountant procedure sheet for licensure - Alaska ...
certified public accountant procedure sheet for licensure - Alaska ...
certified public accountant procedure sheet for licensure - Alaska ...
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MAIL COMPLETED APPLICATION AND FEES TO: CPA<br />
State of <strong>Alaska</strong><br />
Department of Commerce, Community and Economic Development<br />
Division of Corporations, Business and Professional Licensing<br />
BOARD OF PUBLIC ACCOUNTANCY<br />
550 West 7 th For Division Use Only<br />
Avenue, Suite 1500<br />
Anchorage, AK 99501<br />
Phone: (907) 269-4712 Fax: (907) 269-8156<br />
E-mail: license@alaska.gov<br />
Website: www.commerce.alaska.gov/occ/<br />
APPLICATION FOR CERTIFIED PUBLIC ACCOUNTANT LICENSE<br />
Nonrefundable Application Fee: $ 50.00 Make checks payable to: STATE OF ALASKA<br />
Certification Fee: $ 220.00<br />
Wall Certificate (Optional): $ 20.00<br />
I HEREBY APPLY <strong>for</strong> Certification by EXAMINATION Certification by RECIPROCITY<br />
(Must have at least four years post exam<br />
experience within last ten years)<br />
1. Name:<br />
Last First M.I. Maiden or Other Names<br />
Salutation: Mr. Mrs. Ms. S.S.N:<br />
2. CONTACT INFORMATION<br />
Mailing Address:<br />
Daytime Telephone Number:<br />
(Required by AS 08.01.060)<br />
City State ZIP Code<br />
Area Code<br />
Email Address: ______________________________________________________________________________<br />
3. Date of Birth:<br />
Please send correspondence via Email US Mail<br />
Mo. Day Year<br />
4. EXAM INFORMATION<br />
Passage of Uni<strong>for</strong>m CPA examination:<br />
State(s) Registered: Date Final Section Passed:<br />
Date Ethics Exam Passed? Administered by:<br />
(AICPA Professional Ethics Comprehensive Course required <strong>for</strong> CPA Licensure by Examination)<br />
5. LICENSURE INFORMATION<br />
a. List all Jurisdictions in which you hold or have held certificates/licenses to practice <strong>public</strong> accountancy.<br />
Check here if NONE<br />
State or Jurisdiction License or Permit Number First Issue Date Expiration Date Periods of Lapse?<br />
08-4092 (Rev. 08/22/12) (1)