Cpa Sole Proprietor Firm Permit Renewal Application - Minnesota Board Of Accountancy - 2017 Page 2
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6M
M
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a
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Ph: 651-296-7938
innesota
innesota
oard of
oard of
ccountancy
ccountancy
CLEAR
CLEAR
Fax: 651-282-2644
85 East 7th Place, Suite 125
85 East 7th Place, Suite 125
FORM
FORM
boa.state.mn.us
St. Paul, MN 55101-2143
St. Paul, MN 55101-2143
2017 CPA SOLE PROPRIETOR FIRM PERMIT RENEWAL APPLICATION
1.
Firm Information
Military Status u Are you active duty or within 6 months of discharge from active duty?
No
Yes
Firm Permit #
Firm Name
Contact Name
Firm Address
(First)
(Last)
City
Phone
Fax
State
Zip
2.
Does your firm have an office
in a state other than
Minnesota?
No—Firm permit renewal fee is
$35.00
Yes—Firm permit renewal fee is
$68.00
($85, if renewal postmarked after
($118, if renewal postmarked after
December 31, 2016)
December 31, 2016)
3.
Does your firm have more than one office
in
Minnesota?
No
Yes
If yes, attach a sheet listing the addresses for all offices and the person in charge at each.
4.
List all CPAs and/or RAPs who work for your firm as employees.
Attach list, if necessary.
Name
CPA Certificate # /
State of
Practicing in
RAP Registration
Residence
Minnesota?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
CPA Sole Proprietor Firm Permit Renewal Form—Page 1 of 5
Rev 02/17
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