Individual Cpa Certificate Renewal Application - Minnesota Board Of Accountancy - 2016 Page 6
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7Inactive Renewals
9.
Designation Affidavit for
Read all statements and sign the affidavit below.
1. I am not required to have an active certificate in Minnesota;
2. I will not use the CPA designation in a way that may lead a person to believe that I hold an
active certificate in Minnesota;
3. I will place the word “inactive” adjacent to my CPA title;
4. I am not engaged in the practice of public accounting in Minnesota; and
5. I will not engage in the practice of public accounting in Minnesota without obtaining an active
certificate.
Affidavit: I swear or affirm that I have read the foregoing renewal application
and that the statements are true and complete.
Printed Name
Signature
Certificate Number
Date
Daytime Phone Number
CPA Certificate Renewal Form—Page 5 of 6
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