Application Form For Initial Permit To Practice As A Cpa In Kansas Page 2
ADVERTISEMENT
1
27. HAVE YOU EVER HAD THE RIGHT TO PRACTICE BEFORE THE UNITED STATES TREASURY DEPARTMENT OR
ANY OTHER GOVERNMENTAL BODY OR AGENCY CANCELED?
YES
NO
(If yes, attach full explanation.)
8. WITHIN THE LAST SEVEN YEARS, HAVE YOU BEEN DELINQUENT IN FILING YOUR TAX RETURNS? (IF YES,
PLEASE ATTACH A FULL EXPLANATION.)
YES
NO
9. WITHIN THE LAST SEVEN YEARS, HAVE YOU BEEN DELINQUENT IN FILING TAX RETURNS AND/OR PAYING TAXES
COLLECTED ON BEHALF OF OTHERS FOR WHICH YOU WERE RESPONSIBLE? (I.E., WITHHOLDING TAXES, SALES TAX,
USE TAX, ETC. NOTE: ENTERING INTO A PAYMENT PLAN DOES NOT MEAN YOU ARE CURRENT.) (IF YES,
PLEASE ATTACH A FULL EXPLANATION.)
YES
NO
10. ARE YOU FAMILIAR WITH THE CODE OF PROFESSIONAL CONDUCT OF THE KANSAS BOARD OF ACCOUNTANCY
UNDER WHICH YOU ARE EXPECTED TO ABIDE AND DO YOU AGREE THAT YOU WILL COMPLY WITH THE CODE? YES
NO
11. DO YOU UNDERSTAND AND AGREE THAT YOU ARE REQUIRED TO OBTAIN A SPECIFIC AMOUNT OF
CONTINUING PROFESSIONAL EDUCATION IN ORDER TO RENEW YOUR PERMIT TO PRACTICE AS A CPA IN
KANSAS?
YES
NO
(INDICATION OF THE AMOUNT OF CPE TO BE OBTAINED WILL BE ATTACHED TO YOUR PERMIT CARD.)
(OVER)
12. PROVIDE THE FOLLOWING DATA FOR EACH CPA THAT CAN VERIFY QUALIFYING EXPERIENCE FOR YOU, AND SEND THEM ONE
OF OUR EXPERIENCE VERIFICATION FORMS ATTACHED. INTERNSHIPS MAY NOT BE USED TOWARD THE EXPERIENCE
REQUIREMENT. (
You are not required to provide 3 different sources of experience, we have merely provided space for that amount, if necessary. These forms may be
reproduced if necessary.)
Firm/business name:______________________________________________________________________________________________________________
Firm/business mailing address:______________________________________________________________________________________________________
Name/title of permit-holding CPA verifying experience:______________________________________________________________________
Verifier’s mailing address if different from above:_____________________________________________________________________________________
Dates employed:_________________ to _________________
Part-time hours worked _______________ Full-time months worked _________________
Firm/business name:______________________________________________________________________________________________________________
Firm/business mailing address:______________________________________________________________________________________________________
Name/title of permit-holding CPA verifying experience:______________________________________________________________________
Verifier’s mailing address if different from above:_____________________________________________________________________________________
Dates employed:_________________ to _________________
Part-time hours worked _______________ Full-time months worked _________________
Firm/business name:______________________________________________________________________________________________________________
Firm/business mailing address:______________________________________________________________________________________________________
Name/title of permit-holding CPA verifying experience:______________________________________________________________________
Verifier’s mailing address if different from above:_____________________________________________________________________________________
Dates employed:_________________ to _________________
Part-time hours worked _______________ Full-time months worked _________________
14. PERMIT FEE: (non-refundable)
(CPA certificates ending in odd-numbers are licensed in odd-numbered year biennials; CPA certificates ending in even-
numbers are licensed in even-numbered year biennials. Biennial periods begin on July 1. The permit fee for those
applying for more than one year remaining in the appropriate biennial period pay $150; those applying for one year or
less remaining in the appropriate biennial only pay $75. Applications pending for more than 120 days from date of
receipt will be cancelled and all fees forfeited.)
FORM OF PAYMENT:
CHECK
CREDIT CARD
Credit Card: VISA
MASTERCARD
AMERICAN EXPRESS
DISCOVER
CREDIT CARD #
________ ________ ________ ________
EXP. DATE (MO/YR) ________ ________
________________________________________________
NOTE: IF USING A BUSINESS CREDIT CARD, PLEASE PROVIDE THE VERIFICATION
CARDHOLDER’S SIGNATURE
CODE FOUND ON THE BACK OF THE CREDIT CARD. _______________
I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND ACCURATE.
_____________________
_____________________________________________________________________________________________
Date application signed
Signature of CPA applying for permit to practice
Please Print/Type Name_____________________________________________________________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial