Cpa Firm Permit Renewal Application - Minnesota Board Of Accountancy - 2017 Page 4
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62017 FIRM PEER REVIEW STATEMENT
1.
Did or will your firm do one or more of the following?
2016
2017
Audits of Financial Statements
Yes
No
Yes
No
Reviews of Financial Statements
Yes
No
Yes
No
Compilations of Financial Statements
Yes
No
Yes
No
Examinations of Prospective Financial Information
Yes
No
Yes
No
If you answered “Yes” to any of the above, complete questions 2-5.
If you answered “No” to all of the above, sign the following affidavit, then skip to the next page.
I swear or affirm that during the past year my firm did not perform attest or compilation services. The firm does not plan
to do so in the coming year and if the firm does engage in such practice, I will immediately notify the Minnesota State
Board of Accountancy (Board). I, therefore, request on behalf of the firm exemption from the peer review requirements
of the Board. I further certify that this information is correct and understand that my deliberate misrepresentation may
result in the suspension and/or revocation of my certificate and the firm’s permit.
Printed Name
Signature
Name of Firm
Date
2.
Is your firm registered with the Public Company
Accounting Oversight board (PCAOB)?
Yes
No
If yes: A. What year was it registered?
B. When was the last review report on your public practice
released by the PCAOB? (If none released, write “none released.”)
Note:
You must file any released reports with the Board within 30 days of receipt from the PCAOB.
3.
Are you currently participating in a peer review program
with respect to your non-public company practice?
Yes
No
4.
Indicate the Report Acceptance Body (RAB) you are/will be working with:
AICPA
MAPA
MNCPA
Other (specify):
5.
What 12-month period will be reviewed during your next required peer review?
/
to
/
(Beginning Month)
(Beginning Year)
(Ending Month)
(Ending Year)
Note:
You must submit peer review reports no later than 15 months after the end of the year under review or within 30 days of
receipt of the Report Acceptance Body letter, whichever is earlier.
6.
Affidavit:
I certify that the information provided above is complete and accurate.
Printed Name
Signature
Name of Firm
Date
CPA Firm Permit Renewal Form—Page 3 of 5
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