Fillable North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

Fill Online, Printable, Fillable, Blank North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners) Form

Use Fill to complete blank online NC STATE BOARD OF CPA EXAMINERS (NC) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

On average this form takes 13 minutes to complete

The North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners) form is 8 pages long and contains:

  • 0 signatures
  • 36 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

U.S.A. forms for NC State Board of CPA Examiners

BROWSE NC STATE BOARD OF CPA EXAMINERS (NC) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
01-2020
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
APPLICATION PACKAGE FOR RECIPROCAL NC CPA CERTIFICATE
Attached is an application for a reciprocal North Carolina CPA certificate. Please note that you must be currently
licensed to practice public accounting by another jurisdiction before North Carolina can grant reciprocity. To ensure
that you have enclosed all necessary information and that the forms are completed correctly, please review the list
below before returning the application package to the Board. You must complete each form regardless of how long
you have been licensed as a CPA in another jurisdiction. Please keep a copy of all documents for your reference.
NOTE: Thi
s application is necessary only if you reside or plan to reside in North Carolina or if your principal
place of business is in North Carolina.
Applic
ation Form
• Did you answer all questions?
• Did you sign and date the application?
• Is the application properly notarized?
• Did you attach a recent photograph that meets United States passport standards (2” x 2”, color, head and
shoulders)? A photocopy of your driver’s license or passport will not be accepted.
• Did you enclose a copy of the completion/attendance certificate for the North Carolina Accountancy Law
Course?
• Did you enclose a $100.00 check payable to the NC State Board of CPA Examiners or a $100.00 credit
card authorization?
If you w
ere not born in the United States, you must include submit one of the following documents with your
application (other documentation will not be accepted):
• proof of United States citizenship (e.g. copy of your United States passport or copy of your naturalization
certificate);
• proof of resident alien status (e.g. copy of permanent resident card); or
• a notarized statement of your intention to become a United States citizen (template available from the
“Forms & Applications” page of the Board’s website, nccpaboard.gov).
Inter
state Exchange Form - Must be completed by the board of accountancy (BOA) that issued your original CPA
certificate and/or license. You are advised to ascertain if that BOA has additional requirements and/or fees that
must be met/paid before your information will be released. The Board will accept another BOA’s form as long as it
provides the same information requested on our form. Numerical Uniform CPA Exam scores must be verified by the
jurisdiction in which you sat for the Uniform CPA Exam, even if you were certified/licensed in another jurisdiction. If
you need more than one Interstate Exchange Form, you may make copies or print additional copies from the
Board’s website, nccpaboard.gov.
Tempo
rary Permit - You will be issued a temporary permit prior to the issuance of your reciprocal certificate if you
submit the Reciprocal Application and payment of $100.00. Allow at least two (2) weeks for processing the
temporary permit. Temporary permits are valid for four (4) months and are non-renewable. The temporary
permit is a statement confirming that you are in good standing in the jurisdiction issuing your certificate and that you
are entitled temporarily to use the CPA title and engage in the public practice of accountancy in North Carolina for a
stated period. The reciprocal application is completed when you submit proof of completion of the accountancy law
course, the interstate exchange form completed by the jurisdiction that issued your original certificate, and by a
jurisdiction that proves current licensure. The remaining documentation to complete the Reciprocal Application must
be received within 90 days of the date of issuance of your temporary permit. Board staff will provide a deadline
when the temporary permit is issued. Failure to complete the reciprocal application process will result in the
expiration of the temporary permit. You must then reapply and must pay the application fee again.
CPA F
irm Registration - If you are in the public practice of accounting as defined in 21 NCAC 08A .0307 and
.0308, and the CPA firm through which you are providing services has a North Carolina office, you must register
that CPA firm with the Board. CPA firm registration forms are available from the Forms & Applications page of the
Board’s website, nccpaboard.gov.
Check the st
atus of your application: https://bit.ly/2S4EMlz
01-2020
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
ACCOUNTANCY LAW COURSE REQUIREMENT
Pursuant to 21 NCAC 08F .0504 and 21 NCAC 08H .0101(a), all North Carolina CPA
certificate applicants and reinstatement applicants must complete a qualified
accountancy law course on the North Carolina Accountancy Law (Statutes) and
Administrative Code (Rules).
To satisfy the requirement, an applicant must complete the course within one year
preceding the date the Board receives his or her application. For example, if you plan to
apply for licensure in February, then you should take the course no earlier than March
of the prior year. If an applicant meets the requirement prematurely, the course will not
count for certification or reinstatement. The Board suggests that an applicant take the
course within a few months prior to submitting his or her application to the Board.
For new CPA certificate applicants, the course will qualify for 400 CPE credit minutes
that may be reported on the CPE renewal form if completed during the same
calendar year in which the certificate is granted.
The North Carolina Association of CPAs (NCACPA) course, "NC Accountancy Law
Course: Ethics Principles and Professional Responsibilities," is the qualified course
that is available in two formats: a 400-minute group study seminar and a
400-minute self-study course.
"NC Accountancy Law Course: Ethics, Principles, and Professional Responsibilities"
NCACPA
PO Box 80188
Raleigh, NC 27623-0188
(919) 469-1040
(800) 722-2836
www.ncacpa.org
PLEASE NOTE THAT THE BOARD DOES NOT OFFER THIS COURSE.
*E
ffective January 1, 2020, CPE credit is calculated in minutes. One CPE hour
equals 50 CPE minutes. An eight-hour CPE course equals 400 minutes.
*
*
01-2020
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
APPLICATION FOR RECIPROCAL NC CPA CERTIFICATE
NOTE: APPLICATION WILL NOT BE PROCESSED UNLESS ALL FIELDS ARE COMPLETED.
Full Name (First/Middle/Last/Suffix)
Birthplace (City, State, Country) Birthdate (MM/DD/YYYY)
Social Security Number Home Email Address
Home Address (Street or PO Box and City, State, Zip Code)
Home Telephone Number Home Fax Number
Business/Firm Name
Business Address (Street or PO Box and City, State, Zip Code)
Business Telephone Number Business Fax Number
Business Email Address Job Title
Send mail to (check one): Home Business
OCCUPATION (check one):
Individual Practitioner Educator Govt., Non-Accounting
CPA Firm-Partner Industry, Accounting Field Law
CPA Firm-PC Shareholder/PLLC Member Industry, Non-Accounting Student
CPA Firm-Staff Govt., Accounting Unemployed
AREA OF CONCENTRATION (check one):
General Accountancy Auditing Financial Planning
Taxation Advisory Services Non-Accounting
Administration Law
Check the memberships you hold in the following organizations:
North Carolina Association of CPAs American Institute of CPAs
LICENSE INFORMATION
I hold CPA certificate number dated
from the Board of Accountancy and I am under no discipline by that board. I hold a
license/permit from that board for the period ending which allows me the unrestricted privilege to
use the CPA title and to practice public accountancy in that board’s jurisdiction.
EXAM INFORMATION
Y N I passed all sections of the Uniform CPA Examination with a minimum score of 75 as reported by the AICPA
Advisory Grading Service.
Attach photo
here
01-2020
Employee Fair Classification Act
The 2017 Session of the North Carolina General Assembly passed Senate Bill 407 (Session Law
2017-203), “Employee Fair Classification Act.”
§143-761. Title. This Article shall be known and may be cited as the "Employee Fair Classification
Act."
§143-765. Occupational licensing boards and commissions; notice requirement; applicant
certification and disclosure.
(a) Every State occupational licensing board or commission that is authorized to issue any
license, permit, or certification shall include on every application for licensure, permit, or certification,
or application for renewal of the same, the following:
(1) Certification by the applicant that the applicant has read and understands the public notice
statement.
(2) Disclosure by the applicant of any investigations for employee misclassification and the result
of the investigations for a time period determined by the occupational licensing board or
commission.
(b) An occupational licensing board or commission shall deny the license, permit, or certification
application of any applicant who fails to comply with the certification and disclosure requirements of
this section.
Public Notice Statement
Required by NC Gen. Stat. §143-764(a)(5), effective December 31, 2017.
Any worker who is defined as an employee by NC Gen. Stat.§§95-25.2(4), NC Department of Labor;
143-762(a)(3), Employee Fair Classification Act; 96-1(b)(10), Employment Security Act; 97-2(2),
Workers Compensation Act; or 105-163.1(4), Withholding; Estimated Income Tax for Individuals;
shall be treated as an employee unless the individual is an independent contractor. Any employee
who believes that the employee has been misclassified as an independent contractor by the
employee’s employer may report the suspected misclassification to the Employee Classification
Section within the North Carolina Industrial Commission.
Employee Classification Section
North Carolina Industrial Commission
1233 Mail Service Center
Raleigh, NC 27699-1233
Telephone: (919) 807-2582
Fax: (919) 715-0282
Email: emp.classification@ic.nc.gov
Employee misclassification is defined as avoiding tax liabilities and other obligations imposed by
Chapter 95, 96, 97, 105, or 143 of the North Carolina General Statutes by misclassifying an
employee as an independent contractor [NC Gen. Stat. §143-762(5)].
I certify that I have read and understand the Public Notice Statement: Y N
I certify that I have not ever been investigated by any agency for employee misclassification: (If you
answer no, attach documents applicable to the investigation(s) with this application.) Y N
Signature Date
01-2020
NORTH CAROLINA ACCOUNTANCY LAW COURSE
Completion date (Attach copy of certificate of completion)
MORAL CHARACTER DATA
If you answer "Yes" to any of the questions below, you must provide a certified copy of the court records or a certified copy of
applicable license or disciplinary records and your statement of explanation with this application.
Have you been charged, arrested, convicted, found guilty of, received a prayer for judgment continued, or
pleaded nolo contendere to any offense, inclusive of traffic infractions? If yes, please attach copy of relevant
documents. You are not required to disclose any arrest, charge, or conviction that has been expunged by the court.
Y N
Have you had an application for certificate or license denied or certificate or license suspended, canceled, or
revoked by any state or federal agency or governing or licensing board?
Y N
Have you been investigated, charged, or
disciplined; or are you currently under investigation by a
governing
or
licensing board or by
a state or federal agency?
Y N
Have you been party to any civil suit, bankruptcy action, administrative proceeding, or binding arbitration; the basis of
which is grounded upon an allegation of negligence, dishonesty, fraud, misrepresentation, or incompetence?
Y N
APPLICATION FEE: Enclose a $100.00 check payable to the NC State Board of CPA Examiners or a $100.00 credit card
authorization.
AFFIDAVIT OF APPLICANT
I have read General Statutes Chapter 93 and Title 21, North Carolina Administrative Code, Chapter 08 and do understand
the law and rules of the Board applicable to all certified public accountants, particularly those about Professional Ethics
and Conduct, and, the Continuing Professional Education requirements. As far as I am able to determine, I meet all of the
requirements to apply for a North Carolina CPA Certificate. I understand the contents of applications including all
attachments and disciplinary actions or consent orders regarding me are subject to the NC Public Records Act. I
understand that I am waiving any claim of confidentiality or privacy regarding disclosure of such public records. I authorize
the Board to make such investigative inquiries it deems necessary and release from liability all parties responding to such
inquiries. I affirm under the penalties of perjury that the information, statements, and any attachments made in conjunction
with this application are true, correct, and complete.
Signature Date
State
County
Signed and sworn to (or affirmed) before me this day by
(Name of Applicant)
Witness my hand and official seal, this the day of , 20 .
Official Signature of Notary
, Notary Public
Notary’s printed or typed name
My commission expires:
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
AUTHORIZATION FOR INTERSTATE EXCHANGE
OF EXAMINATION & LICENSURE INFORMATION
TO THE APPLICANT: This form is essential to the application you are filing with this Board. Before your application will be
considered for approval, certain information must be verified by the board of accountancy (BOA) where your Uniform CPA
Exam credits and/or certificate and license status were established. Before sending this form for completion by that entity,
contact the entity to determine if you need to meet additional requirements or pay any fees before such information will be
released.
Complete the applicant portion of this form and forward the form and a self-addressed, stamped envelope to the BOA
where credits and/or status were established. The BOA will complete the remainder of this form (Sections A-D) and return
it to you. This Board will accept another BOA’s own form as long as it provides the same information requested on this
form. Include the completed form sent to you by the BOA with the rest of your application package submitted to this Board.
TO BE COMPLETED BY THE APPLICANT:
Full Name (First/Middle/Last/Suffix)
Mailing Address (Street or PO Box and City, State, Zip Code)
Daytime Telephone Number CPA Certificate No. (if applicable)
Birthdate (MMDDYYYY) Social Security Number
I hereby request and authorize the Board of Accountancy to provide any and all
pertinent information requested in this form to the North Carolina State Board of Certified Public Accountant Examiners to
accompany an application filed with that agency. I agree that the State Board may confirm the grades issued to me by the
Advisory Grading Service of the American Institute of Certified Public Accountants.
Applicant Signature Date
FO
R ACCOUNTANCY BOARD USE ONLY
The information provided herein is correct to the best of our knowledge.
Board/Agency
OFFICIAL
BOARD Official Signature
SEAL
Title Date
01-2020
SECTIONS A THROUGH D ARE TO BE COMPLETED BY THE BOARD OF ACCOUNTANCY ONLY
SECTION A: VERIFICATION OF EXAMINATION CREDITS
The following are grades awarded on the Uniform CPA Examination(s) for the applicant named above, as reported by the AICPA
Advisory Grading Service and approved unchanged by this board. Please use Section D of this form to explain if any of the grades
were changed; if an exam other than the Uniform CPA Exam was used; or if there is any reason why the grades should not be
accepted. If separate sheets are attached, please affix official signature and board Seal to all pages.
Please list all grades, including failing grades, recorded for applicant.
Date
of Examination
AICPA
ID Number
AUD
Auditing
FAR
(FARE/Theory)
REG
(ARE/Practice)
1) Was the applicant ever denied admission to the Exam? Y N If yes, complete Section D of this form.
2) If the applicant has not completed the CPA Exam, are there any restrictions preventing him/her from sitting in your jurisdiction?
Y N If yes, complete Section D of this form.
3) Number of subjects with which candidate is credited, if any. Number N/A
4) Date credits or grades expire, if any. (MMDDYYYY)
SECTION B: CERTIFICATE/LICENSURE (PERMIT) STATUS
Certificate as a Certified Public Accountant:
1) The applicant holds original CPA Certificate number dated (MMDDYYYY) that is in good
standing unless otherwise noted in Section D of this form.
2) The applicant holds reciprocal CPA Certificate number dated (MMDDYYYY) that is in
good standing unless otherwise noted in Section D of this form.
License/Permit to Practice Public Accounting: If licensing is the responsibility of another agency, please forward and request
completion of applicable section.
3) The applicant holds a license/permit from this board for the period ending (MMDDYYYY) and is currently in
good standing in this State. Please note any exceptions to the above statements in Section D of this form.
4) If the applicant does not hold a license/permit from your Board, please indicate the requirements to be met for issuance or
reinstatement:
License/Permit not required ....................................................................
Pay appropriate fees and/or post bond ...................................................
Complete acceptable accounting/auditing experience ............................
Complete continuing professional education requirements ....................
Other (please specify)
5) Has there ever been any disciplinary action instituted against the applicant? Y N If yes, complete Section D of this
form.
SECTION C: ADDITIONAL INFORMATION REQUESTED: If CPA certificate is valid and unrevoked, but a license to practice public
accountancy is not held, may applicant refer to himself as a "CPA" in your jurisdiction? Y N
SECTION D: EXCEPTIONS NOTED OR EXPLANATIONS OF INFORMATION PROVIDED On an additional sheet, explain answers
to above questions as needed. Official Seal and Signature must be affixed to all attached sheets.
01-2020
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • Raleigh NC 27605 Phone
919-733-1422 • Fax 919-733-4209 • Web nccpaboard.gov
CREDIT CARD PAYMENT
Credit card payment cannot be processed unless all fields below are complete.
VISA Amount $
MasterCard
Account Number
Card Security Code Expiration Date
(located on back of card near or in signature box) (MM/YYYY)
Exact Name on Card
Billing Address for Card
Street or PO Box and City, State, Zip Code
Signature Date
FOR BOARD USE AUTHORIZATION CODE
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document