Individual Registered Accounting Practitioner Renewal Application - Minnesota Board Of Accountancy - 2017

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M
B
a
Ph: 651-296-7938
innesota
oard of
ccountancy
CLEAR
CLEAR
Fax: 651-282-2644
85 East 7th Place, Suite 125
FORM
FORM
boa.state.mn.us
St. Paul, MN 55101-2143
2017 INDIVIDUAL REGISTERED ACCOUNTING PRACTITIONER RENEWAL APPLICATION
Send this renewal and your check (made payable to MN Board of Accountancy)
to the address above
postmarked on or before December 31,
2016.
Please answer ALL questions.
1.
Personal Information
(You must include both your home and work information even if you are self-employed.)
Military Status
I am active duty or within 6 months of discharge from active duty:
u
No
Yes
Preferred “mail to”:
Home
Business
Name
Employer Name
(First)
(M.I.) (Last)
(Suffix)
Certificate #
Work Phone
Home Phone
Work Fax
Home Address
Work Address
City
Work City
State
Zip
Work State
Work Zip
2.
Select Status
(Mark choice in first column)
Renewal Fee
Renewal Fee
ü
Status for 2017
(If renewal postmarked
(If renewal postmarked
on or prior to 12/31/2016)
after to 12/31/2016)
Active
$100
$150
Surrender Registration
$0
$0
3.
Are you employed by a RAP firm?
If yes, indicate business type below. If no, go to question 4.
Yes
No
Limited Liability Company
Professional Corporation
Partnership
Sole Proprietorship
List name of practice:
Limited Liability Partnership
4.
If you are not employed by a RAP Firm, indicate business type below:
College or University
Financial Services Company
Law Firm
CPA Firm or Sole Proprietorship
Governmental
Other business
List agency:
Note:
• All firms engaged in providing compilation services in Minnesota must obtain a RAP firm permit.
• RAP firms (including Sole Proprietors) must renew their firm permit every year.
RAP Renewal Form—Page 1 of 3
Rev 01/17

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