Application For Minnesota Cpa Firm Permit - Minnesota Board Of Accountancy Page 2
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685 East 7th Place, Suite 125, St. Paul, MN 55101-2143
Ph: 651-296-7938 • Fax: 651-282-2644 • boa.state.mn.us
CLEAR
CLEAR
FORM
FORM
APPLICATION FOR MINNESOTA
CPA FIRM PERMIT
1.
FIRM INFORMATION
Are any of the firm’s owners, partners, shareholders, members, directors, or officers an active duty military
No
Yes
member? Or have left service in the last two years with an honorable or general discharge?
Proposed Firm Name
Firm Address
Main Phone
City
State
Zip
FEIN # or MN Taxpayer ID #
Name of Manager /
MN Certificate #
Partner in Charge
(if applicable)
(First)
(Last)
2.
Does your firm have more than one office
in
Minnesota?
No
Yes
If yes, attach a sheet listing the addresses for all offices and the person in charge at each.
3.
Provide the date the firm was formed
and select the firm type below:
(MM/DD/YYYY)
CPA Corporation
CPA Limited Liability Partnership
CPA Partnership
CPA Limited Liability Company
4.
List all CPAs and/or RAPs at your firm and provide the requested detail.
Attach list, if necessary.
Name
Minnesota
Owner, manager,
Practicing in
CPA Certificate or
director or officer?
Minnesota?
RAP Registration #
(if applicable)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Application for CPA Firm Permit—Page 1 of 5
Rev 10/17
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