2021 Annual Registration / CPE Report
Payment of $185 required.
Fields marked with an asterisk (*) are required.
First Name*:
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Last Name*: |
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Preferred Address |
Firm Name: |
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Address*: |
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Address (continued): |
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City*: |
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State*: |
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Zip*: |
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Country*: |
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Home Phone: |
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Nonpreferred Address |
Firm/Company: |
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Address: |
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Address
(continued): |
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City: |
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State: |
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Zip: |
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Other Information |
Firm Phone: |
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Direct Phone: |
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Fax: |
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ND CPE Certificate #*: |
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Email Address*:
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Check all appropriate boxes: (Required) |
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I have had a certificate, license, practice privilege, or permit cancelled, revoked, suspended, or not renewed in any state or jurisdiction for any cause. |
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I have had my right to practice public accountancy revoked or suspended in any state or by a federal agency. |
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I have been a party to a civil suit, bankruptcy action, administrative proceeding, or binding arbitration, the basis of which was grounded upon an allegation of dishonesty, fraud, or gross negligence in the performance of services as a certificate holder or licensee, or in the filing or failure to file the your own income tax returns. |
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I have been convicted of a felony, or of any crime an element of which is dishonesty or fraud, under the laws of the United States, State of North Dakota, or of any other state. |
Check all appropriate boxes and follow prompts: (Required) |
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I do not hold out as a CPA or LPA in ND. Sign and submit form with fee. Listing CPE is optional. |
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I hold out as a CPA or LPA in ND and perform accounting, auditing, management or financial
advisory, consulting, bookkeeping, or tax services, for a client
or an employer’s client. Sign and submit form with fee and CPE detail.
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All others who hold out as a CPA or LPA in ND. Sign and return form with fee and CPE detail. |
ATTESTATION: I hereby certify and affirm that I have successfully completed the required hours of continuing education during the licensing period of July 1, 2020 through June 30, 2021. If audited, I agree to provide documentation that verifies I have met the requirements as claimed. If the North Dakota State Board of Accountancy concludes that I have not complied with the requirements set forth in N.D.A.C. § 3-03-01, I hereby agree to waive my right to an administrative hearing and appeal pursuant to N.D.C.C. Ch. 28-32 and agree that the Board may issue an order taking disciplinary action against my license. The information contained in this application is true and correct to the best of my knowledge. I understand that under the North Dakota Century Code 43-02.2-09(1)(a) providing false information is grounds for disciplinary action against my certificate to practice public accountancy.
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Initals* (Required): |
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" Notice: A percentage of renewal applications may be randomly selected for an audit of compliance with continuing education requirements. If selected, you must submit copies of certificates or other acceptable proof that you satisfied the continuing education requirements as you have stated on this application. You are required to save your documents so you can respond to audits. Licensees unable to comply with the audit may be subject to disciplinary action against your certificate
Please print a copy for your records BEFORE hitting Submit
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