North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
(No annual renewal fee, CPE, or return of CPA certificate required)
Full Name (First/Middle/Last/Suffix)
NC CPA Certificate Number
Mailing Address (Street or PO Box and City, State, Zip Code)
Is this a change of address?
Yes No
Daytime Telephone Number:
Email Address:
I desire to be classified as inactive. I have read the rules of the Board found in 21 NCAC
08A .0301(b)(20), 08A .0308, 08J .0105, and 08J .0106 and understand that under North Carolina
Accountancy Statutes and Rules, I cannot use the title Certified Public Accountant (CPA) or
allow anyone to refer to me as a Certified Public Accountant (CPA) in North Carolina or as an
inactive CPA. I will not assume or use, in writing or orally, directly or indirectly or through third
parties, “any words, letters, abbreviations, symbols or other means of identification” to identify myself
as being licensed as a CPA or as an inactive CPA. Such representation includes, but is not limited to,
“…the use of titles or legends on letterheads, reports, business cards, brochures, resumes, office
signs, telephone directories or any other advertisements, news articles, publications, listings, tax
return signatures, signatures on experience or character affidavits for exam or certificate applicants,
displayed membership in CPA associations, displayed CPA licenses from this or any other state, and
displayed certificates or licenses from other organizations which have the designation ‘CPA’ or
‘Certified Public Accountant’ by the [my] name.”
An individual who is licensed as a CPA in another jurisdiction and who does not reside in North
Carolina and does not have an office in North Carolina may request inactive status of his or her North
Carolina CPA certificate and exercise his or her practice privilege in North Carolina pursuant to
NCGS 93-10.
I affirm that I will not identify myself as a CPA, nor will I allow anyone else to identify me as a CPA, to
any person in any manner as specified in 21 NCAC 08A .0308(a) and (b) as long as I am on inactive
status. I affirm that the information shown above is true and accurate.
Signature: Date:
NOTE: Inactive status is effective immediately upon submission of this form.
For your convenience, you may email this completed form to Alice Grigsby (aliceg@nccpaboard.gov.)