MAIL THIS FORM AND YOUR CHECK OR MONEY ORDER TO STATE OF ALASKA:
DEPARTMENT USE ONLY
Department of Community and Economic Development
Alaska State Board of Public Accountancy
Division of Occupational Licensing
P.O. Box 110806
Juneau, Alaska 99811-0806
APPLICATION FOR REINSTATEMENT
Please refer to the last page of this application for information concerning reinstatements.
The amount due for
reinstatement depends upon how long the license has been lapsed. The current biennial fee is $220.00. Licenses lapsed
for less than three years must pay the biennial fee due for the entire time the license has been lapsed. Licenses lapsed for
more than three years pay no more than three times one year's portion of the fee that would have been required, providing
the board determines the failure to renew was excusable. Please note that licensing fees are subject to change and the
fee currently in place may not be the fee that was in place during the entire time the license was lapsed. Contact the division
for correct fee information.
Daytime Telephone No.:
3 x Annual Fee
Date of Birth:
Social Security No.:
The Passage of Uniform CPA examination:
List all Jurisdictions in which you hold or have held licenses to practice public accountancy.
Check here if NONE
State or Jurisdiction
License or Permit Number
First Issue Date
Periods of Lapse?
High School Name
College or University
08-4144 (Rev. 9/00)