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Application For D.C. License OPLA-24 - District Of Columbia
| Application For D.C. License Form. This is a District Of Columbia form and can be used in General Corporations Division Secretary Of State . |
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ATTENTION Please Note: The attached form is only the application. There is a more complete CPA information package that is being developed to be included with the application. Please contact the DCRA Business Center for the information package. They may be reached at 202-442-8959. American LegalNet, Inc. www.USCourtForms.com OPLA-24 (Rev. 10/85) DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS OCCUPATIONAL AND PROFESSIONAL LICENSING ADMINISTRATION P.O. BOX 37200 WASHINGTON, D.C. 20013-7200 APPLICATION FOR D.C. LICENSE FOR OFFICE USE ONLY AMOUNT OF FEE DATE PAID BASIS OF LICENSURE EXAMINATION test score RECIPROCITY $ ENDORSEMENT OTHER state state APPLICATION NO. date CATEGORY CODE AUDIT/LICENSE NO. COMPLAINTS Fll.ED Yes No MIS ONLY STREET CODE QUADRANT CODE APPLICATION EXAMINATION LICENSE BOARD APPROVED LICENSE PERIOD from to TO BE COMPLETED BY APPLICANT (PLEASE READ INSTRUCTIONS FIRST) (PRINT IN INK OR TYPE) Examination 11. DATE OF APPLICATION 6. BASIS OF Individual 5. 1. TYPE OF LICENSE Partnership Corporation 2. NAME OF APPLICANT (Last, First, MI) 3. RESIDENCE ADDRESS (Street, City, State, Zip Code) 7. SEX Male Female 8. TRADE NAME OR EMPLOYER NAME 4. BILLING ADDRESS (Street, City, State, Zip Code) 9. BUSINESS ADDRESS ( Street, City, State, Zip Code ) 10. D.C. WARD 17. SCHOOL ATTENDED (name, city, state or foreign country) 18. Total No. of hours 19 Date of Graduation 20. APPLICATION Re-examination Reciprocity Endorsement Other ( specify) * 12. SOCIAL SECURITY NUMBER 13. DATE OF BIRTH 14. PLACE OF BIRTH 15. TELEPHONE NUMBER Residence Business 16. CERTIFICATE OF OCCUPANCY (if applicable) NUMBER 21. Year Degree Received Type of Degree/Certificate 22. Have you ever been arrested or convicted of a crime? (omit traffic violations) Yes No If yes, attach explanation. 24. Are you now or have you ever been licensed in D.C. or any other jurisdiction? If yes, give the following information on original liceuxure: License No. License Date 23. Are you currently bonded? If yes, give expiration date No Yes Jurisdiction Issue Basis Yes No Yes No 25. Have you ever surrendered license or has license been denied, revoked or suspended by any jurisdicton? If yes, attach explanation. 26. AFFIDAVIT OF APPLICANT , being duly sworn, deposes and says: That the information given in this application, including all writings and exhibits attached hereto, is true and complete. District of Columbia ss. Subscribed and sworn to before me this appeared before me. ( SEAL ) My Commission expires day of Signature of Applicant , 20 by the affiant, who personally Notary Public 1. All applicants must complete applicable portions of supplemental page and submit all supporting doucments required. 2. Fee must accompany application. All fees are earned when paid and cannot be transferred or refunded. 3. Make checks payable to D.C. TREASURER. A charge of $50.00 will be imposed for dishonored checks. (Public Law 89-208) 4. False or misleading statements will be cause for rejection of application or revocation of license. 5. If more space is needed to fully answer questions, attach additional page(s). *Under the authority of Public Law 93-579, Section 7(b), the Department of Consumer and Regulatory Affairs requests your Social Security Number to assist in the administration of D.C. tax laws. Disclosure is not required as a part of the licensing process and will not be made available to the public. American LegalNet, Inc. www.USCourtForms.com
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