Firm Registration Form - Texas Board Of Professional Land Surveying printable pdf download

Office Use Only

Firm #

SURVEYING

TEXAS BOARD OF PROFESSIONAL LAND

12100 Park 35 Circle, Building A, Suite 156, MC-230, Austin TX 78753

Entity #

Phone: 512 239-5263 Fax: 512 239-5253

Receipt #

FIRM REGISTRATION FORM

State law requires that a person engaging in the Practice of Surveying in this State under any business title other than the real name of

one or more persons authorized to engage in public or state land surveying, whether individually or as an association, partnership, or

corporation, shall file with the Texas Board of Professional Land Surveying, in the manner prescribed by the Board, a certificate

stating the full name and place of residence of each person engaging in the practice and the place, including the street address, city and

zip code, where the practice or business is principally conducted. Mark N/A when appropriate. Any changes to the business are to be

reported to the board including closure. Mail the form to the Board office at the address noted above with a $32.11 fee. Each location

(branch office) offering land surveying services has to be registered and pay the fee by completing the Branch Registration Form. The

fee must be in the form of a check or money order (no cash) made payable to the Texas Board of Professional Land Surveying.

Firm’s Legal Name:

DBA (if applicable):

Mailing Address:

Physical Address:

Address

City

County

State

Zip

Telephone:

Fax:

E-mail:

Subsidiary and/or Branch Office offering land surveying services. ⁭ None or Number:

**Complete Branch Registration Form for each Subsidiary and/or Branch Office**

3A.

Name(s) and title(s) of Managing Owner(s) _________________________________________________________________

Contact E-mail Address _______________________________________________ Telephone ________________________

3B.

Name(s) and title(s) of Partner(s), Officer(s) or Director(s) of firm: _____________________________________________

____________________________________________________________________________________

Name(s) of full time Registered Professional Land Surveyors employed at this location:

Full Name of Surveyor

RPLS #

Residence Address

Telephone Number

**Affirmation of employment to be signed and sealed by each RPLS who is an employee of firm (use page 2 for RPLS signature and seal)**

Signature of Remitter __________________________________________________________________

Print Name _________________________________________________________________________

Position with Firm___________________________________ Amount Enclosed _______________Date_______________________

Firm is required to renew its registration and pay the designated fee prior to January 1 of each year to offer land surveying services in the

next year. If a firm branch does not renew its registration and pay the designated fee prior to January-1-of each year, the firm’s branch

registration will be deemed expired. Any surveying services offered without a valid renewed registration is in violation of the Professional

Land Surveying Practices Act and subject to sanctions and penalty fees provided for under the Act or as promulgated by the Board

Reference: Land Surveying Practices Section 10171.352 and Section 1071.353, also Board Rules §661.55, §661.56, §661.57

Please attach additional information regarding branch offices, directors and surveyors as needed.

Firm Registration Form - Texas Board Of Professional Land Surveying

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