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CPA

Alaska Department of Community and Economic Development

Division of Occupational Licensing

P.O. Box 110806, Juneau, Alaska 99811-0806

Telephone: (907) 465-2580

E-mail: License@dced.state.ak.us

BIENNIAL CERTIFIED PUBLIC ACCOUNTANT/

PUBLIC ACCOUNTANT LICENSE RENEWAL

January 1, 2000

December 31, 2001

IT IS TIME TO RENEW YOUR LICENSE

Your license to practice as a CPA/PA in the State of Alaska expires on December 31, 1999. It is illegal for you to practice if your license

has expired. There is no grace period. To renew your license for the period from January 1, 2000, through December 31, 2001, return this

signed , notarized application to the above address with a check or money order payable to the State of Alaska. This is the only renewal

notice you will receive. Incomplete applications or insufficient fees will result in your renewal being rejected.

RENEWAL DUE DATE

For prompt processing, submit this renewal application on or before December 1, 1999. Do not submit

IS DECEMBER 31, 1999

your application early if you have not completed your continuing education.

NAME CHANGE

If you have had a legal name change since your last license was issued, enclose a certified true copy

of the legal document (marriage certificate, divorce decree, etc.) as proof of the change.

EXPIRED LICENSES

If you choose not to continue to practice public accounting, you may renew your license as "Inactive."

If you choose not to renew your license, it may be reinstated at a later date in accordance with

12 AAC 04.440, AS 08.04.425, and AS 08.04.440. Licenses lapsed less than one year may be

renewed by completing this form and complying with renewal requirements.

PAYMENT OF CHILD SUPPORT If the Alaska Commission on Postsecondary Education has determined you are in loan default, or if

AND STUDENT LOANS

the Alaska Child Support Enforcement Division has determined you are in arrears on child support, you

will be issued a nonrenewable, temporary license valid for 150 days. Contact Postsecondary Education

at (800) 441-2961 or (907) 465-2961 in Juneau and Child Support Enforcement at (907) 269-6659 to

resolve payment issues.

PUBLIC INFORMATION

Please be aware that all information on this renewal form will be available to the public, unless required

to be kept confidential by state or federal law.

BUSINESS LICENSES

Renewal applications for business licenses will be mailed separately. For more information about

business licenses, call (907) 465-2550.

LICENSE RENEWAL FEE (Check one)

ACTIVE

Individual CPA ..................................................$220.00

Individual PA (not certified)...............................$135.00

Prorated Active Renewal Fee...........................$110.00

(for licenses 1813 and above)

Per AS 08.04.410, a person who holds an INACTIVE

INACTIVE (Proof of continuing education not required)

license may not practice public accountancy.

............................................................................$135.00

Name:

Last

First

Middle

Office Use Only

Corrected Mailing Address (complete only if your address is different than the address label shown above):

PMD _____________

Daytime Telephone Number:

License Number:

QR ______________

Social Security Number:

Date of Birth:

________ ________

SSN required per AS 08.01.100 — Your license will not be renewed unless we have your SSN on file.

08-4060 (Rev. 10/99)

CONTINUED ON REVERSE SIDE

(1)

Form 08-4060b - Biennial Certified Public Accountant/ Public Accountant License Renewal

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