Initial Firm Registration - Oregon Board Of Accountancy Page 5
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NO
Has this firm, or a version of this firm, been previously registered with the Board? If yes, what was
the previous firm name?
Is this an entity change?
Is this firm registered in any other State/Jurisdiction? If yes, please provide list on separate page
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FIRM LITIGATION AND OTHER REGULATORY ENFORCEMENT REPORT
NO
YES
A) Has any licensed CPA/PA associated with the firm in Oregon or performing services for
Oregon clients, had any professional license suspended, revoked, or restricted, or been the subject
of any regulatory investigation or action (IRS, SEC, DOL etc.)
B) Has any lawsuit, settlement or arbitration involving fraud, dishonesty or misrepresentation
relating to the professional services of the business organization or relating to the practice of public ac-
counting been filed against the firm or against any owner or manager of the firm?
C) Has any criminal action been filed against the firm or any owner or managing partner of the firm?
(1)
D) Has any owner or employee of the firm been convicted
of a felony or of any crime in which an
essential element is dishonesty, fraud, or misrepresentation?
(1) "Conviction" includes verdict or finding of guilt, plea of no contest, plea agreement or pronouncement of sentence by a trial
court, even though the conviction many not be final and the sentence may not actually be imposed until appeals are exhausted.
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COMMISSIONS, REFERRAL FEES and CONTINGENT FEES
Indicate if the firm pays or receives any of the following forms of compensation for services:
REFERRAL FEES
COMMISSIONS
CONTINGENT FEES
If the firm is required to be licensed by any regulatory authority or organization to pay or receive commissions or fees reported in this
section, provide the name of each agency that issues such licenses and the license numbers held by the firm.
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FIRM EMPLOYEE and OWNERSHIP INFORMATION
A) Provide the following information for ALL who are licensed accountants working in an Oregon office or serving
Oregon clients. Attach additional pages if necessary.
Name
License Number
Issuing State
Ownership % (if any)
B) Licensee responsible for Oregon activities:
License Number
Issuing State
C) Non-CPA/Non-PA owner(s):
Name
Title
Ownership %
2015 INITIAL FIRM REGISTRATION PG 2
Questions? Please contact: (503) 378-2264 / angel.m.legler@oregon.gov or kimberly.fast@oregon.gov / 503-378-2268
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