Individual Cpa Certificate Renewal Application - Minnesota Board Of Accountancy - 2016 Page 7
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7Exempt
10.
Notification of Election to Become
from Certificate Renewal
Read all statements and sign the affidavit below.
1. I am not required to have an active certificate in Minnesota;
2. I am not engaged in the practice of public accounting in Minnesota;
3. I will not engage in the practice of public accounting in Minnesota without obtaining an active
certificate.
4. I will not use the CPA designation in any manner or hold out in any manner (in accordance with
the provisions of Minnesota Rules 1105.3700 (2013));
5. I certify that I have complied with all of the CPE requirements applicable to me; and
6. I understand the requirements in Minnesota Rules 1105.3700 (2013) relating to this election.
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 6 of 6
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