West Virginia Board of Accountancy
106 Capitol Street, Suite 100
Charleston, WV 25301-2610
(304) 558-3557 Fax: (304) 558-1325
Renewal Fee: |
$85.00 |
Late Fee (after June 30 postmark |
|
deadline*) |
50.00 |
(*late fee applies from July 1 - July 31)
After July 31, please contact the Board office for the proper procedure
Annual CPA Certificate or PA Registration Renewal
(for the period beginning July 1, 2014 through June 30, 2015)
Your license or registration cannot be issued unless the Renewal Form is complete. Include additional sheets as necessary. Send original form with signature to Board office. Photocopy the completed form for your files. (Type or print very legibly)
License Number: _______________________________Please print my home G business G in the roster (select only one)
Name: ________________________________________________________________________________________________________
Home Address: ________________________________________________________________________________________________
Employer: _____________________________________________________________________________________________________
Employer Address: ______________________________________________________________________________________________
Employer Phone: _________________________ Fax: _____________________________ Cell: ________________________________
E-m ail address: _________________________________________________________________________________________________
Please list all states in which you have a CPA or PA certificate/license _____________________________________________________
I am not practicing public accounting and do not wish to renew my license at this time. (Complete form & return to |
|
Board office . No fee required.) |
|
Please change my status from “Active” CPA to “CPA-Inactive”. (Complete form and return with the |
|
CPA -Inactive fee of $65.00 renew able annually.) |
$ |
Sect ion 1 : Eligibility Verificat ion Q ues tionn aire:
1. |
Have you met the Board's CPE Requirem ents and received a Confirmation Letter for the most recent calendar year? |
Yes G No G |
2. |
Do you perform attest/compilation services as a sole-practitioner (not organized as a firm) in West Virginia? |
Yes G No G |
|
If yes, do you have an approved Authorization to provide attest/compilation services as an individual licensee? |
Yes G No G |
|
Fo r qu est ion s 3-1 0 b elo w: Sinc e yo ur la st re ne wa l per iod , hav e yo u: ( If Y ES, e nc lose com ple te d eta ils reg ard ing y ou r an sw er.) |
3. |
Been convicted of a felony? |
Yes G No G |
4. |
Been convicted of a misdemeanor other than a minor traffic violation? |
Yes G No G |
5. |
Been found by a govern ing body or a state or federal agency to have committed a violation of the statutes or |
|
|
rules governing Certified Public Accountants or Registered Public Accountants in the practice of accountancy? |
Yes G No G |
6. |
Been a defendant in any legal proceeding in relation to your individual conduct, competence or ethics in your |
|
|
practice as a Certified Public Accountant or Registered Pub lic Accountant? |
Yes G No G |
7. |
Been censured, admonished or reprimanded or had your certificate or license revoked or suspended by any State's |
|
|
licensing board? |
Yes G No G |
8. |
Been censured, admonished or reprimanded or had membership revoked or suspended in any accounting |
|
|
professional organization (such as AICPA, National Association of Public Accountants, or any State Society |
|
|
of CPAs' or Public Accoun tants' organizations)? |
Yes G No G |
9. |
Been refused admission to practice accounting or any other occupation by any state or federal licensing board? |
Yes G No G |
10. Been disciplined, reprimanded or sanctioned by any governmental agency? |
Yes G No G |
|
|
|
Section 2: Child Support Ob ligation: Pursuan t to W.Va. Code §48-15-303, each application for licensure or license renew al must an sw er th e fo llow ing q ue stio ns a nd cer tify, u nd er p en alty o f false sw ear ing, th at th ese an sw ers are tru e an d co rre ct.
1. |
Do you have a child support obligation? |
Yes G No G |
2. |
If the answer to question 1 is yes, are you in arrearage? |
Yes G No G |
3. |
If the answer to question 2 is yes, does your arrearage equal or exceed the amount of child |
|
|
support payable for 6 months. |
Yes G No G |
4. |
Are you the subject of a child support related sub poena or warrant? |
Yes G No G |
Section 3: By signing and dating this form below, I do certify, under penalties of perjury and false swearing, that the information I have submitted is true and correct to the best of my knowledge. Making a false statement may subject the certificate or registration holder to disciplinary action including, but not limited to, revocation or suspension of the certificate or registration.
