REV. 11-2017
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 INDIVIDUAL PRACTITIONER
21 NCAC 08J .0108 requires all CPA firms to register with the Board and re-register annually in
accordance with NCGS 93-12(8a) and 21 NCAC 08J and 08K. There is no fee for registering as an
individual practitioner.
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 individual practitioner 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:
Supervising CPA’s Certificate No.:
Mailing Address:
City, State & ZIP:
Street Address:
City, State & ZIP:
Phone Number:
Fax Number:
Email Address:
Website Address:
Signature Date
KEEP A COPY OF THIS DOCUMENT FOR YOUR RECORDS.
