2015 Registered Accounting Practitioner Renewal Application - Minnesota Board Of Accountancy

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Minnesota Board of Accountancy
Phone: 651-296-7938
th
85 East 7
Place, Suite 125
Fax: 651-282-2644
Saint Paul, Minnesota 55101-2143
Clear this form.
2015 Registered Accounting Practitioner Renewal Application
Be sure to complete all questions.
All Registered Accounting Practitioner (RAP) registrations expire on December 31, 2014.
Applications must be postmarked on or before December 31, 2014 to be considered “on
time.” A $50 delinquency fee is required for all renewals postmarked after the December 31,
2014 deadline. The licensee is responsible for fees incurred due to incomplete applications.
1. Personal Information
(You must include both your home and work information even if you are self-employed.)
Name:_____________________________
Employer Name: ____________________
(First)
(Last)
(Suffix)
Work Address: ______________________
Registration #: ______________________
Work City, State _____________________
Home Phone #: ______________________
Work Zip: __________________________
Home Address:______________________
Work Phone #: ______________________
City, State: _________________________
Daytime Fax #: ______________________
Zip:_______________________________
E-mail: ____________________________
Preferred Mailing Address:
Home
Work
2. Select Status (Place checkmark in the first column)
Active - $100.00
Surrender Credential – No fee
3. Are you employed by a RAP firm?
Yes
No
If yes, indicate business type below. If no, go to question 4.
Limited Liability Company
Professional Corporation
Sole Proprietor
Partnership
(list name under which you practice below)
Limited Liability Partnership
_______________________________
Note:
-
All RAP firms are required to apply for (or renew) a firm permit for 2015.
-
Sole Proprietors must complete a RAP firm permit application (or renewal) and Quality
Review Statement and return those forms with this renewal application.
-
All firms engaged in providing compilation services in Minnesota must obtain a 2015
RAP firm permit.
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