Inactive Registration Application Form - State Of Nebraska Board Of Public Accountancy
Download a blank fillable Inactive Registration Application Form - State Of Nebraska Board Of Public Accountancy in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Inactive Registration Application Form - State Of Nebraska Board Of Public Accountancy with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2NEBRASKA BOARD OF PUBLIC ACCOUNTANCY
P.O. Box 94725, Lincoln, NE 68509-4725
(402) 471-3595 or (800) 564-6111
APPLICATION FOR INACTIVE REGISTRATION
Section 1-136 of the statutes allows any certificate holder who has not lost his/her right to issuance or
renewal of a permit and who is not actively engaged in the practice of public accountancy to file a written
application with the board to be classified as inactive.
Only individuals who have completed the
appropriate experience will be issued a permit to practice or an inactive registration. If renewing a
current Inactive Registration, the deadline is June 30.
Application must include fee of $70 and an original signature. Incomplete applications will be returned
unprocessed and deemed not to have been received.
Certificate #: __________________
Birth Year: _________ EVEN _________ ODD
NAME: ____________________________________
Mailing Address: _______________________________________________
Street or PO Box
_______________________________________________
City
State
Zip
Home Phone: _______________________
Work Phone:_______________________
E-mail Address: ____________________
Fax Number:_______________________
DISCLOSURE STATEMENTS (Pursuant to Section 1-137 of the Public Accountancy Act)
1. Since the date of your last application, have you been charged or convicted of a felony by any court of any state or of
the United States? (If yes, please attach a separate page giving disposition, charges, dates and locations.)
No.
Yes.
2. Since the date of your last application, have you been charged or convicted of any crime, an element of which is
dishonesty or fraud, by any court of any state or of the United States? (If yes, please attach a separate page giving
disposition, charges, dates and locations.) Title 288 Rules, Chapter 6 002
No.
Yes.
3. Since the date of your last application, have you had any application for certification or licensure denied, or any
professional or vocational license or membership revoked or suspended, or been named in or subject to other
disciplinary action regarding such a license or membership in this state or any other state, or by the United States
government? (If yes, please attach a separate page providing details regarding the action taken, by what agency, dates
and locations.)
No.
Yes.
PLEASE COMPLETE REVERSE SIDE
State Board Use Only
(5/14) Date Recd.______________
Check #_____________
Rect. # _____________
Amt./Code:
$70 (04-7511)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Registration Of Assumed Business Name Application Form - State Of Montana - Secretary Of State
Legal
Registration Of Foreign Limited Partnership Application Form - State Of Montana - Secretary Of State
Legal
Form Cra - Combined Registration Application For State Of Delaware Business License And/or Withholding Agent - Division Of Revenue
Financial
Related Categories
Parent category: Legal