Cpa Sole Proprietor Firm Permit Renewal Application - Minnesota Board Of Accountancy - 2017 Page 3
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65.
A) Provide the names of all owners, managers, directors and officers of the firm who
or
reside in
practice in Minnesota.
Attach list, if necessary.
Be sure to complete a
Non-CPA Owner of Firm Statement
(page 5) and enclose the $45.00 fee for each individual listed below
who is not a CPA.
Name
CPA Certificate #
State of
Practicing in
Residence
Minnesota?
(if applicable)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
non-CPA
in
total, what percentage of:
B) The
owners in the list above hold,
Voting interest in the firm?
%
Financial interest in the firm?
%
Firm Permit Renewal
6.
Designation Affidavit for
Read all statements and sign the affidavit below.
If a statement does not apply to your firm, mark “N/A” on the line next to that statement.
1. All employees who hold a certificate or have been granted practice privileges under
Minnesota Statutes §326A.14 (2016) and who are responsible for supervising attest
or compilation services or who sign or authorize someone to sign an accountant’s
report on financial statements on behalf of the firm have met the competency
requirements set forth in professional standards for such services.
2. All attest and compilation services rendered by the firm in this state are under the
charge of a person holding a valid certificate with an active status or a person who
has been granted practice privileges under Minnesota Statutes §326A.14 (2016).
3. The firm has an audit documentation retention and destruction policy that complies
with Minnesota Rules 1105.7800.F (2015).
4. The firm has verified that all non-CPA owners have completed a Non-CPA Owner of
Firm Statement and registered with the Board.
5. The firm has verified that two-thirds of all CPA owners, managers, directors and
officers of the firm who have their principal place of business located in Minnesota
have an active certificate for 2017.
Affidavit: I swear or affirm that I have read the foregoing renewal application
and that the statements are true and complete.
Printed Name of Certificate Holder/Owner
Signature of Certificate Holder/Owner
Name of Firm
Date
CPA Sole Proprietor Firm Permit Renewal Form—Page 2 of 5
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