General Permit To Practice Form - 2000
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1
2
3CPA
STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
ALASKA STATE BOARD OF PUBLIC ACCOUNTANCY
P.O. BOX 110806
JUNEAU, ALASKA 99811-0806
(907) 465-3811
E-mail: license@dced.state.ak.us
GENERAL PERMIT TO PRACTICE
(AS 08.04.420)
FEE:
Application
$
50.00
Initial License
$ 100.00
TOTAL
$ 150.00
I / We hereby make application for a Permit for General Practice as:
o CPA
o CPA Partnership
o CPA Corporation
o Limited Liability Company
o Limited Liability Partnership
Firm Name:
Address:
Street
City
State
ZIP Code
Daytime Telephone:
Contact Person:
1. I / We hold a permit to practice public accountancy in good standing in the State of
.
Permit Number:
Expiration Date:
2. I / We do not hold a permit for an individual Alaska CPA/Alaska CPA partnership, or Alaska CPA Corporation.
3. I / We do not maintain an office in the State of Alaska.
I CERTIFY THAT, to the best of my knowledge, the statements contained in this application are true and correct.
I
understand that any false or misleading information herein may result in failure to obtain registration and licensure in the
State of Alaska.
Signature of Applicant
Title
Date of Application
SUBSCRIBED AND SWORN TO before me this
day of
,
.
Notary Public
SEAL
My Commission Expires:
The General Permit expires one year from the date of issue, and may be renewed upon written request, completion of
application and payment of fees. Contact the division for renewal information. For information on obtaining a permanent
permit to practice, contact the state board administrator at the telephone number listed above.
08-2443 (Rev. 9/00)
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