Individual Rap Registration Renewal - Minnesota Board Of Accountancy - 2018
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385 East 7th Place, Suite 125, St. Paul, MN 55101-2143
Ph: 651-296-7938 • Fax: 651-282-2644 • boa.state.mn.us
B O A R D O F A C C O U N T A N C Y
CLEAR
CLEAR
FORM
FORM
2018 INDIVIDUAL RAP REGISTRATION RENEWAL
ALL individuals MUST RENEW by December 31, 2017
A $50 delinquency fee is required for renewals postmarked after that date.
Send this form and your check (payable to Board of Accountancy) to the address above.
No cash, credit card, or bill pay. Renewals received without payment ENCLOSED will be returned.
If you have questions regarding your renewal, please call the Board office at 651-296-7938.
1.
PERSONAL INFORMATION
Military Only
u
If you are active duty or within 6 months of discharge from active duty, check box:
Home
Business
All Applicants
u
What is your preferred “mail to” address?
Not currently employed
Retired
u
Check the appropriate box if you are:
q
Provide Home and Work Contact Information
If you are employed/self-employed, you must include both your home and work information.
Name
(First)
(M.I.) (Last)
(Suffix)
Registration #
Employer Name
Home Phone
Work Phone
Home Address
Work Address
City
City
State
Zip
State
Zip
2.
SELECT STATUS
Mark choice in first column. Pay the fee corresponding to your choice and when you are renewing.
X
RENEWAL FEE
ü
STATUS FOR 2018
Postmarked
Postmarked AFTER 12/31/17
ON or BEFORE 12/31/17
Active
$100
$150
Surrender Registration
$0
$0
DATA PRACTICES ACT WARNING
The data you furnish on this form will be used by the Board to process your license renewal. You are not legally required to provide this data;
however, if you fail to do so, the Board may be unable to issue your license. Until licensure is granted all application data, except name and
designated address, are private data pursuant to Minnesota Statute §13.41, subdivision 2 (2016). All data except social security number become
public record when licensure is granted pursuant to Minnesota Statute §13.41, subdivision 5 (2016).
RAP Registration Renewal Form—Page 1 of 3
Rev 12/17
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