Form 08-613 - Cpa Partnership Registration And Permit To Practice (Page 3 of 3) in pdf

Form 08-613 - Cpa Partnership Registration And Permit To Practice Page 3

ALASKA STATE BOARD OF PUBLIC ACCOUNTANCY

AUTHORIZATION FOR INTERSTATE EXCHANGE OF LICENSURE INFORMATION

This form is essential to the application you are filing with this board. If you are a nonresident partnership, please have the

state in which you established original licensure as a partnership complete this form. You are advised to check with that

board before forwarding this form to determine if there are additional requirements to be met before the information will be

released.

SECTION A

TO BE COMPLETED BY THE APPLICANT (Please type or print legibly)

Name of Partnership:

Mailing Address:

City:

State:

ZIP Code:

Daytime Telephone Number:

I hereby request and authorize the

to provide any and all

pertinent information requested in this form to the Alaska Board of Public Accountancy to complete and application filed with

that agency.

Signature

Date Signed

SECTION B

LICENSE/PERMIT TO PRACTICE PUBLIC ACCOUNTING

The partnership identified in Section A of this form holds a license/permit issued by this board on

which

remains valid until

and is currently in good standing in this state. (Please note any exceptions to the above

statement in Section D of this form.)

License No.:

Issue Date:

Expiration Date:

License Status:

Current

Lapsed

Pending Litigation

Suspended

Revoked

Have partners met the continuing education requirement?

Yes

Number of hours per year

SECTION C. ADDITIONAL INFORMATION

SECTION D. EXCEPTIONS OR EXPLANATIONS OF INFORMATION PROVIDED

This information provided herein is correct to the best of our knowledge.

Board

OFFICIAL BOARD SEAL

Board Official Signature

Please return this form to:

Department of Community and

Economic Development

Title

Alaska State Board of Public Accountancy

P.O. Box 110806

Juneau, Alaska 99811-0806

Date

(907) 465-3811

08-613a (Rev. 9/00)

Form 08-613 - Cpa Partnership Registration And Permit To Practice Page 3

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