Application For Retired Cpa/pa License Status - Oregon Board Of Accountancy (Page 2 of 3) in pdf

Application For Retired Cpa/pa License Status - Oregon Board Of Accountancy Page 2

6. Are you now or have you ever applied for or been issued a certificate

Yes

or license as a CPA or PA in any other jurisdiction?

If yes, name of jurisdiction:

Date Issued:

Current Status

7. Have you ever been charged, convicted, pleaded nolo contendre or found

*Yes

guilty of any criminal offense (excluding non-criminal traffic violations)?

*If you answer yes, download a disposition form from the Board website

and submit completed form with this application.

8. Have you ever been under investigation by any regulatory or licensing

*Yes

agency?

* If yes, please explain on a separate attachment. Include the State, type of license and outcome of the

matter.

9. Have you ever had a professional or vocational license denied, suspended,

*Yes

or revoked by this or any other state, jurisdiction or foreign country?

*If yes, explain the details on a separate attachment. Include the State where the incident took place and the

type of license involved.

10. Describe the professional activities in which you intend to engage while holding a “Retired” status license.

11. Do you intend on performing any audit or attest work for compensation

Yes

while holding a “Retired” status license?

12. Do you intend to sign any tax returns as a CPA/PA preparer, for

Yes

compensation, while holding a “Retired” status license

Certification

I certify that:



All information submitted by me in this application is true and accurate



If I am granted Retired license status, I will not perform any public accounting services for

compensation



If I am granted Retired license status, I will use only the designation “CPA Retired”



I understand that Retired license may be restored to active status only at the Boards’ discretion upon

a showing of good cause

Signature

Date

January 2016

Retired Status Application

Oregon Board of Accountancy

Application For Retired Cpa/pa License Status - Oregon Board Of Accountancy Page 2

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