Application For Amendment For Certificate Of Authorization For Corporate, Limited Liability Company (Llc), Or Limited Liability Partnership (Llp) Practice Form 2000 Page 2

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8. GENERAL INFORMATION QUESTIONS: Has the corporation, LLC, LLP, or any of the personnel designated in responsible
charge or any principles of the corporation, LLC, or LLP been convicted of fraud, gross negligence, incompetence, or misconduct
in the practice of architecture, engineering, land surveying, or landscape architecture, or of a U.S. or state statute excluding minor
traffic violations?
If yes, please attach explanation with legal documentation.
Yes
No
9. All information provided with this application is considered public information.
10. I certify under penalty of perjury that the information furnished is true and correct.
Date
Signature of Authorized Agent
Title:
08-4409 (Reg. 11/00)

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