ALABAMA STATE BOARD OF PUBLIC ACCOUNTANCY
PO Box 300375, Montgomery, AL 36130-0375
Application For Certificate by Reciprocity
1. Mrs. ________________________________________________________________________, hereby apply for
waiver of the examination requirements as provided in the Public Accountancy Act of 1973, and issuance of a certificate as a Certified
Public Accountant. I am a Certified Public Accountant of _______________________________________________________
holding Certificate No. __________________, issued ______________________, year ________________ , which certificate is active,
in good standing and in full force and effect. I hold reciprocal C. P. A. certificate(s) issued by the following jurisdictions (List all C. P. A.
reciprocal certificates you have received, showing certificate number, date issued and jurisdiction. If, in addition to the original C. P. A.
certificate previously identified, you also have received other certificates as a result of passing the Uniform C. P. A. Examination in
other States, so indicate and list certificate numbers, dates, and States.)
I am familiar with the Public Accountancy Act of 1973, Rules and Regulations, the code of professional ethics promulgated by
the Board and the instructions accompanying this application. As a condition of this application I pledge full observation of said law,
Board rules and regulations, and code of professional ethics.
If any of the answers to the following questions be false, or if I be guilty of non-disclosure of material information in making this
application, I hereby disqualify myself ipso facto. If any false statement or material non-disclosure remains undiscovered by the Board
until a Certified Public Accountant’s certificate has been issued to me, I hereby agree to surrender and forfeit the certificate and to