REV. 02-2018
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1423 • Fax 919-733-4209 • Web nccpaboard.gov
REGISTRATION OF AN ADDITIONAL OFFICE OF CPA FIRM
21 NCAC 08J .0108 requires all CPA firms to register with the Board and re-register annually in
accordance with NCGS 93-12(8)(a) and 21 NCAC 08J and 08K.
Pursuant to 21 NCAC 08N .0306(c), the firm’s name on letterhead, contracts, engagement letters, tax
returns, and all professional services reports must match exactly the firm’s name as registered with
the Board and if applicable, the NC Department of Secretary of State.
To register an additional office of a CPA firm, fill in the fields below and submit the completed form to
the Board by mail, fax or email (cemery@nccpaboard.gov):
CPA Firm Name:
Supervising CPA’s Name:
Supervising CPA’s Certificate No.:
Mailing Address:
City, State & ZIP:
Street Address:
City, State & ZIP:
Phone Number:
Fax Number:
Email Address:
Website Address:
Is this the firm’s administrative office? Yes No
Signature Date
Title
KEEP A COPY OF THIS DOCUMENT FOR YOUR RECORDS.
