THE OREGON BOARD OF ACCOUNTANCY IS MOVING! - Oregon.gov

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THE OREGON BOARD OF ACCOUNTANCY
             IS MOVING!

                     The Board office is moving to

          200 Hawthorne Ave SE - Suite D450
                    Salem, Oregon 97301

         Our move is scheduled for the week of May 18, 2020.
Please do NOT fax your renewal application between May 19 – 29 as our
     machine will not receive faxes while the data lines are moved.

         As always, please feel free to call the Board office at
   503-378-4181 or email boa.info@oregon.gov with any questions.
OREGON BOARD OF ACCOUNTANCY
                  2020-2022 RENEWAL PERIOD ENDS JUNE 30, 2020
                  INSTRUCTIONS FOR RENEWAL APPLICATION
Enclosed is your 2020-2022 Renewal Application for even-numbered licensees. If you hold a current active status license, you will be
required to report 80 hours of CPE including 4 hours of ethics CPE. If you currently hold an inactive license, you will be required to report
32 hours of CPE. If renewing for the first time in Oregon, you may have pro-rated CPE and are required to report at least 4 hours of
Oregon-specific ethics from an Oregon approved sponsor.

An electronic version of the renewal is posted on the Board’s website: www.oregon.gov/boa. All renewals must be received on or
before June 30, 2020 in order to avoid a late fee. Proof of timely submission will be determined by the fax transmittal information or by
the postmark issued by the USPS or other commercial carrier. All renewal applications received by fax on or after July 1, 2020 or
received by mail postmarked on or after July 1, 2020 will be late and will be required to pay the late fee. The late fee is $255 for
active, $50 for inactive and $50 for retired.

                     DO NOT E-MAIL YOUR RENEWAL APPLICATION

 The Basics:
Verify and/or update both residence and business addresses. If you have a new employer and/or residence address, you must report
the change on your renewal. Please note that Board rule requires licensees to report any change in address or employment within 30
days.

All licensees, regardless of your licensing status (active, inactive, retired or voluntary license lapse), must review and answer all
background certification questions on the renewal. If there are unanswered questions, your renewal will not be processed. If you have a
reporting requirement under this section, please attach a thorough explanation of the event(s). (page 4)
Active licensees are required to report a minimum of 80 hours of CPE and report at least 24 hours of CPE taken within each year of the
renewal period* (July 1, 2018- June 30, 2019 and July 1, 2019 – June 30, 2020). Failure to do so will result in the assessment of a 16-
hour CPE penalty. Any carry-forward hours you have may be used toward the penalty hours, however carry-forward hours cannot be
used toward the 24 hour annual requirement. If you failed to meet the minimum annual or total CPE requirement, you can report the
additional 16 hours with your renewal to avoid a delay in renewing your license. *New licensees or licensees who recently reinstated
may have a pro-rated annual requirement and/or total amount of CPE due.
If you recently reinstated your CPA or PA license or a municipal auditor license, any hours used to reinstate may not be used for the
CPE required to renew your license(s).
All licensees, regardless of your licensing status (active, inactive, retired or voluntary license lapse), must complete all employment
questions on the renewal. If there are unanswered questions, your renewal will not be processed. If you are performing attest or
compilation services in Oregon or for Oregon clients, you are required to be employed by a firm that is registered in Oregon. If your
circumstances do not fit into the categories listed, please explain under the “other” option. Failure to complete will delay your renewal
application. (page 3)
Be sure to sign the renewal form. (page 4). If renewing to inactive (section A) or retired (section B) status or if you choose to let
your license lapse (section C), you must also sign page 5 of the renewal application. All licensees are required to complete the renewal
application in its entirety regardless of the status they are renewing under.

 CPE:
Licensees must report all CPE taken between July 1, 2018 – June 30, 2020 in chronological (date) order. The CPE report must
include the title of the course as listed on the certificate of completion. If the course is self-study, you must also include the 6-digit
NASBA National Registry number associated with the sponsor.
Licensees may take unlimited technical CPE, however, there is a 16 hour limit for non-technical CPE courses for active renewals
and an 8 hour limit for non-technical CPE for inactive renewals. Examples of non-technical subjects include (but are not limited to)
interpersonal management skills, public relations, practice development, practice administration, marketing, personnel/HR, and
personal development. If non-technical hours are reported in excess of the allowed total, the additional hours will be deleted and may
result in a CPE penalty if the deletion causes a shortage in total hours reported or a shortage in the 24 hour annual requirement. The
maximum carryforward allowed for active licensees is 20 hours and the maximum carryforward allowed for inactive licensees is 8
hours.
Oregon now allows CPE courses to be taken in any credit increment and all CPE credits are calculated based on a 50-minute hour.
For example, a 25 minute course earns .5 CPE credits, while a course that is 1 hour 20 minutes (80 minutes) would earn 1.6 CPE
credits.
Ethics CPE: NEW REQUIREMENTS
Effective July 1, 2020, all active and inactive licensees must report at least 4-hours of Oregon-specific ethics from a sponsor that
is registered with the Board office, which means that this requirement will not affect your license renewal this period, but a reminder
that the Oregon-specific ethics will be required on your next renewal cycle. A list of the registered sponsors can be found on the
Board’s website www.oregon.gov/boa

The AICPA Ethics course required to obtain an initial license cannot be used toward the ethics requirement for renewal or toward
the general CPE requirement.

REPORTING REQUIREMENTS:
The Board has updated reporting requirements effective January 1, 2020. OAR 801-030-0020(3)

Licensee must notify the Board within 45 days of resolution of any civil action against a licensee that relates to professional services and
business operations involving an Oregon licensee or Oregon clients; initiation of any regulatory action against the licensee; resolution of
any regulatory action against the licensee; any inquiry into the licensees conduct through a professional organization; or resolution of
any professional organization inquiry.

Licensees must notify the Board within 10 days of initiation of any criminal investigation against the licensee or resolution of any criminal
investigation against the licensee.

Firms must notify the Board within 45 days of resolution of any civil action against the Firm that relates to professional services,
business operations or practices of the registered firm in Oregon; resolution of any civil action against any Oregon licensee affiliated
with the firm that relates to professional services, business operations or practices of the registered firm in Oregon; initiation of any
regulatory action against the firm; resolution of any regulatory action against the firm; initiation of any regulatory action against any
Oregon licensee affiliated with the firm; resolution of any regulatory action against any Oregon licensee affiliated with the firm; any
inquiry into an Oregon firms conduct through a professional organization; or resolution of any inquiry of an Oregon firm from a
professional organization.

Firm must notify the Board within 10 days of initiation of any criminal investigation against the Firm; resolution of any criminal
investigation against the Firm; or initiation of any criminal investigation against any of the following individuals affiliated with the firm:
Oregon licensee, Oregon Partner, Oregon Owner.

Licensees and Firms must provide the following information to the Board when reporting any of the events above:

    •    Name of the regulatory agency, court or professional organization;
    •    Title of matter;
    •    Docket number if applicable;
    •    Date of occurrence of the event;
    •    Name of any legal representatives involved;
    •    Statement of the facts; and
    •    Copies of relevant documents, including but not limited to, regulatory notice, civil complaint, criminal charging document, and
         any settlement documents.
Incomplete applications will not be processed.
Any of the following common errors may result in an incomplete application:
Fees:
   •    Application received without the fee or with an incorrect fee (see fee schedule below)
   •    Failure to include payment of Municipal Auditor Fee (if applicable)
   •    Checks payable to an incorrect payee (i.e. OSCPA, AICPA, DOR, etc.)
   •    Missing credit card information (i.e. amount, signature to authorize payment, expiration date or using a credit card other than
        Visa or MasterCard)
Address:
   • Failure to include both employer and residence address
   • Failure to provide a physical address when a PO Box is used
   • Failure to choose which address to be used for mailings
CPE:
    •   Failure to use the correct CPE format – CPE can be reported using excel or similar program, however, it must be in the
        EXACT format provided by the Board on the renewal application and must include readable text (size and font). CPE courses
        are to be reported in chronological (date) order.
    •   Failure to submit the required number of CPE hours
    •   Failure to provide the 6-digit NASBA Registry Number for self-study CPE
    •   Reporting CPE taken outside the reporting period
    •   Failure to take an Ethics Course
    •   Failure for licensees renewing for the 1st time to take an Oregon-specific ethics course
Other:
   • Failure to complete all sections of the renewal form. Regardless of the status renewing to (active, inactive, voluntary lapse or
       retired) the entire renewal must be completed
   • Failure to complete practice information on page 3 of the renewal
   • Failure to sign the renewal (page 4 and page 5 if applicable)
   • Failure to disclose 100% of services being performed by licensee
   • Failure to answer all background questions and submit required documentation

Failure to submit a complete renewal application may result in assessment of late fees, additional CPE required,
significant delays in processing, or the lapse of your CPA/PA license.

FEES:
ACTIVE               $255        INACTIVE                 $50           RETIRED                $50          MUNICIPAL               $150
ACTIVE LATE FEE      $255        INACTIVE LATE FEE        $50           RETIRED LATE FEE       $50          MUNICIPAL LATE FEE      $150

*Late fees will be assessed for all renewals that are received by fax or postmarked on or after July 1, 2020. Late fees cannot be
waived.

Receipts for Payment – Receipts will not be provided between June 19 – July 14, 2020.                If you would like a receipt for
payment, please make your request by email to boa.info@oregon.gov and a receipt will be emailed to you as soon as possible.

                            THE BOARD OFFICE IS MOVING THE WEEK OF MAY 18, 2020
                                     The new address for the Board of Accountancy office is:

                                                       200 Hawthorne Ave SE
                                                             Suite D450
                                                     Salem, Oregon 97301-5289
If you are interested in serving on the Board or a committee, please indicate so on page 1 of the renewal application.

The mission of the Board of Accountancy is to protect Oregon consumers by ensuring only qualified licensees practice public
accountancy in accordance with established professional standards and promulgated rules. If you are interested in giving back to the
profession, please consider the service opportunities listed below.

Board - The Board is responsible for licensing and regulating Certified Public Accountants, Public Accountants, and public accounting
firms in Oregon and meets approximately 4 times per year in person at the Board office. The Board is currently recruiting an actively
licensed CPA or PA to serve on the Board. If you are interested in Board service, please contact Kimberly Fast, Executive Director, by
phone at 503-378-2280 or by email at Kimberly.fast@oregon.gov for more information.

Complaints Committee (BOACC) – The BOACC provides technical assistance to Board staff in the investigation of complaints received
by the Board. The BOACC reviews investigation reports and makes recommendations to the Board. This committee meets
approximately 4 times per year in person at the Board office.

Qualifications Committee (QC): This committee reviews experience requirements for individuals whose experience was gained in
private industry or government settings. The QC reviews the experience as it relates to the seven core competencies and makes
recommendations to the Board for approval or denial of an initial license. The QC meets approximately 4 times per year in person
at the Board office.

Peer Review Oversight Committee (PROC): The PROC oversees and monitors approved peer review programs. The committee
also reviews peer review reports submitted by firms and monitors results and actions taken by the peer review programs. This
committee meets approximately 2-4 times per year in person at the Board office.

Laws and Rules Committee (LRC): This ad-hoc committee reviews current Board rules and statutes and makes recommendations to
the Board. The LRC meets in person at the Board office as needed.

Helpful Links:

Verify Self-Study course registry information: https://www.nasbaregistry.org/sponsor-list
Oregon Administrative Rules: http://www.oregon.gov/boa/Pages/adminrules.aspx
OREGON BOARD OF ACCOUNTANCY
                               200 Hawthorne Ave SE, Ste D450, Salem, OR 97301-5289
                           PH (503) 378-4181 ▪ FAX (503) 378-3575 ▪ www.oregon.gov/BoA
                Renewal of CPA/PA License – DUE DATE: June 30, 2020 for EVEN-Numbered Licensees only
                                                                                                            License #:
                                                                                                              Muni #:
                                                                                                 Carryforward Hours:
  Active $255        Inactive $50          Retired $50          Muni $150                      Ethics Hours Required:
                                                                                                      Prorated Hours:
 Name & Mailing Address                                            Alternate Address

              Please use space below to update contact information
  Check one   Firm, Business or Employer name:
   box for
   official
   mailing
              Business Address:
   address

  Business    City                           State                       Zip                      Phone

              Email Address:

              Residence Address:
    Home

              City                           State                       Zip                      Phone

              Email Address:

                          Website                               Daytime Phone                                      Fax

  If you use a Tax Preparer’s Identification Number (PTIN), provide the number:

 Are you interested in serving on the Board or a Committee? (check any that apply)                Yes              No

 Board               BOACC                   Qualifications (QC)          Laws & Rules (LRC)               Peer Review (PROC)

 Clerk                         Date Proc                  SEQ                       Batch                  Last4

Questions? Please contact (503) 378-4181 or boa.info@oregon.gov                 2020 CPA/PA Permit Renewal               P a ge |1
CONTINUING EDUCATION REPORT (List programs in chronological order)
                                                                                                        *CPE           Live (L)     NASBA National          HOURS
                                                                                    DATE              Type (see           or        Registry # (self-       earned
                COURSE TITLE                             SPONSOR                                                        Self-
                                                                                  Completed            below)                         study only)
                                                                                                                      study (S)
 1                                                                                                    T             Live
 2                                                                                                    T             Self-Study
 3                                                                                                    T             Self-Study
 4                                                                                                    T             Self-Study
 5                                                                                                    T             Self-Study
 6                                                                                                    T             Self-Study
 7                                                                                                    T             Self-Study
 8                                                                                                    T             Self-Study
 9                                                                                                    T             Self-Study
 10                                                                                                   T             Self-Study
 11                                                                                                   T             Self-Study
 12                                                                                                   T             Self-Study
 13                                                                                                   T             Self-Study
 14                                                                                                   T             Self-Study
 15                                                                                                   T             Self-Study
 16                                                                                                   T             Self-Study
 17                                                                                                   T             Self-Study
 18                                                                                                   T             Self-Study
 19                                                                                                   T             Self-Study
 20                                                                                                   T             Self-Study
           If you need additional space, attach a photocopy of this report with additional CPE courses. A PDF fillable form can be found on the Board website.
                                           A computer generated form is acceptable only if it is produced in an identical format.
 *CPE Type      CALCULATE TOTAL CPE HOURS CLAIMED FOR EACH CPE TYPE                                                                                     HOURS
      T         All qualifying TECHNICAL CPE courses not otherwise described
      E         Ethics (4 hours required each renewal period; Oregon-specific course required for first renewal)
      M         Municipal Auditing (24 hours required for Municipal Auditors)
      NT        NON-TECHNICAL (limited to 16 hours Active/8 hours Inactive) see instructions for non-technical CPE categories
                CPE Course instructor, author of published books or articles, or discussion leader
      B
                (may not exceed 50% of the total CPE requirement either separately or combined)
      NL        Nano-learning (may not exceed 10% of the total CPE requirement)

                                                                                   (calculate subtotals from this page and all attached pages)          HOURS
     A MINIMUM OF 24 HOURS must be obtained
                                                                                                        Total CPE hours from 7/1/18 – 6/30/19:
         in each year of the renewal period.

 CPE Courses completed on or before June 30, but after the                                              Total CPE hours from 7/1/19 – 6/30/20:
 date you submit this renewal, may be included on the CPE
                                                                                         Carryforward hours applied from last renewal period :
 report. If you are unable to attend or complete a course
                                                                                                                    (max 20 active/8 inactive)
 before June 30, or a course is cancelled, provide written
 notice to the Board describing the credits to be removed                                                          TOTAL CPE HOURS REPORTED:
 from your CPE report.

                                                                                                                             (STAFF USE ONLY)

Questions? Please contact (503) 378-4181 or boa.info@oregon.gov                                      2020 CPA/PA Permit Renewal                          P a ge |2
PRACTICE INFORMATION                                                   REQUIRED TO BE COMPLETED BY ALL LICENSEES

 YOU MUST COMPLETE THIS SECTION                                         Please indicate the types of engagements you
Enter the % of time for each area that applies. If none                 performed from 7/1/2018 – 6/30/2020.
describe your work, please use “other” to explain. You                  If you work in Industry or you perform duties that are not listed, please use
may select multiple work types, but please provide        FULL   PART   “other” to describe your duties that are not listed, for example CFO,
date ranges if applicable.                                TIME   TIME   Controller, Marketing, or HR.
                                                                                                                                                    %
 Public Accounting                                                      Attest*
                                                                                                                                                    %
 Private Company/Industry Accountant                                    Reviews (AR-C Sec 90)*
                                                                                                                                                    %
 Private Company - non-accounting                                       Compilations (AR-C Sec 80)*
                                                                                                                                                    %
 Government Accountant/Auditor                                          Preparation Engagements (AR-C Sec 70)*
                                                                                                                                                    %
 Academia (professor/assistant only)                                    Municipal Audits
                                                                                                                                                    %
 Attorney                                                               Tax
                                                                                                                                                    %
 Unemployed                                                             Financial Planning
                                                                                                                                                    %
 Retired (no employment)                                                Consulting
                                                                                                                                                    %
 Other (non-accounting), please describe                                Bookkeeping
                                                                                                                                                    %
                                                                        Internal Audit/Tax for private company
                                                                                                                                                    %
                                                                        CFO
                                                                                                                                                    %
                                                                        Controller
                                                                                                                                                    %
                                                                        Other (describe)
                                                                                                                                                    %
                                                                        TOTAL

If you performed attest, review or compilation services in Oregon or for Oregon clients from 7/1/2018 - 6/30/2020, under which
registered Oregon firm?

                     I do not perform engagements for Oregon clients and do not work for an Oregon public accounting firm.

 Check all engagement types you intend to perform in Oregon or for Oregon clients from 7/1/2020 – 6/30/2022:
               Audits                             Agreed Upon Procedures                       ERISA Audits                        Broker-Dealer
               Review                             Municipal Audits                             Compilations                        FDICIA

If you work full-time or part-time under a different business name, please provide the name and address of the business below
(including any business that is not public accounting):

Questions? Please contact (503) 378-4181 or boa.info@oregon.gov                            2020 CPA/PA Permit Renewal                     P a ge |3
CERTIFICATION                                                       REQUIRED TO BE COMPLETED BY ALL LICENSEES

 Please answer the following background questions regarding any jurisdiction by clearly marking your answers.
 Failure to answer all questions will result in an incomplete application.
                                                                                                                           YES     NO
 1       Have you ever been arrested, charged with or convicted of any criminal offense (excluding non-criminal traffic
         violations) that you have not previously reported to the Board?
 2       Have you ever been party to any legal proceedings related to professional services that you have not
         previously reported to the Board?
 3       Have you had any professional license suspended, revoked, restricted, disciplined in any way or been the
         subject of any regulatory (including PCAOB) investigation or action that you have not previously reported to
         the Board?
 4       Are you currently under investigation or do you have any pending actions by any regulatory agency?
         If yes, did you previously report to the Board?
 5       Do you have any pending action or investigation from a professional organization (AICPA, OAIA, OSCPA,
         PCAOB, etc)?
         If yes, did you previously report to the Board?
 6       Have you had any entity that issues a professional certification, license, or other credential initiate any
         regulatory action against you that you have not previously reported to the Board?

 If YES response is related to a BOA matter, please note the Case or INQ number:

         By signing below, I certify the truth and accuracy of all statements, answers and representations made in this
          renewal application and CPE report. This includes all supplementary statements. I also certify that all CPE
           programs listed contribute directly to my professional competence as a licensee in the State of Oregon.

                        Failure to provide signature below will result in an incomplete application.

                   Signature                                                                        Date

If you answered YES to any of the questions above and have not previously reported information to the Board, you must provide
the following along with this application:

     •      Name of the regulatory agency, court or professional society;
     •      Title of the matter;
     •      Name of any Oregon licensees or Oregon clients involved;
     •      Docket number, if applicable;
     •      Date of occurrence of the event;
     •      Name of any legal representatives involved;
     •      A statement of the facts;
     •      Copies of relevant documents, including but not limited to, regulatory notice, civil complaint, criminal charging document or
            copies of legal documents indicating your compliance with any requirements imposed upon you; and
     •      If a settlement was reached, provide the settlement agreement along with the final court order.

Reporting requirements for the questions above are not limited to responses in this application. Licensees are required to report
within 45 days of the resolution of any civil action related to professional services involving an Oregon licensee or Oregon client. If
you are reporting an ongoing matter, you must also report to the Board within 45 days of the conclusion of any civil or regulatory
matter and within 10 days of the initiation of any criminal matter/investigation. OAR 801-030-0020(3)

Questions? Please contact (503) 378-4181 or boa.info@oregon.gov                       2020 CPA/PA Permit Renewal             P a ge |4
A        TO RENEW AS INACTIVE STATUS / $50.00
TO RENEW AS INACTIVE STATUS, COMPLETE THIS SECTION and sign the certification on page 4:

I hereby apply for inactive status under ORS 673.220 and OAR 801-010-0120. I certify that:
     •    I hold a license issued under ORS 673.150 or 673.100 which is not suspended, revoked, expired, resigned, or lapsed;
     •    I will not perform any attest, compilation or review services;
     •    I will not prepare any tax returns as a preparer;
     •    I do not practice any other forms of public accountancy as defined in OAR 801-005-0010(41);
     •    I am not employed at a public accounting firm;
     •    I will use the word “inactive” if I use the CPA or PA designation (OAR 801-010-0120).

          Print Name

          Signature (must also sign certification on page 4)                                                   Date

    B        TO APPLY OR RENEW AS RETIRED STATUS / $50.00
TO APPLY OR RENEW AS RETIRED STATUS, COMPLETE THIS SECTION and sign the certification on page 4:
I hereby apply for retired status under ORS 673.220 and OAR 801-005-0010(47). I certify that:

     •    I hold a license issued under ORS 673.150 or 673.100 which is not suspended, revoked, expired, resigned, or lapsed;
     •    I will not perform any attest, compilation or review services;
     •    I will not prepare any tax returns as a preparer if I have been compensated in any manner for my services;
     •    I do not practice any other forms of public accountancy as defined in OAR 801-005-0010(41) for direct or indirect compensation;
     •    I am not employed at a public accounting firm;
     •    I will use the word “retired” if I use the CPA or PA designation (OAR 801-010-0120) or sign any documents related to non-compensated
          services.

If you have not previously applied for retired status, please indicate how you qualify:

           I have held an active license in good standing, to practice public                         I have reached 65 years of age
           accountancy in Oregon for a combined period of not less than 20 years                      Date of Birth:         /       / 19

          Print Name

          Signature (must also sign certification on page 4)                                                   Date

    C        DO NOT INTEND TO RENEW LICENSE / NO COST
I DO NOT INTEND TO RENEW and understand by completing this section, along with the certification on page 4, that my license will LAPSE.

Lapsed licensees are still under the jurisdiction of the Board. I hereby apply for lapsed status under OAR 801-005-0010(28) and I certify that:

     •    I hold a license issued under ORS 673.150 or 673.100 which is not suspended, revoked, expired, resigned, or lapsed;
     •    I will not perform any attest, reviews, or compilation services;
     •    I am not employed at a public accounting firm and will not seek employment at a public accounting firm until I hold an active permit;
     •    I will not prepare any tax returns as a preparer;
     •    I do not practice any other forms of public accountancy as defined in OAR 801-005-0010(41).

Licensees whose license is in lapsed status are not permitted to hold themselves out as a CPA or PA. Licensees who continue to practice with a
lapsed license are subject to civil penalties up to $5,000 per violation and other forms of discipline by the Board for holding out as a CPA or PA and
for practicing without a valid license. Lapsed licenses will expire after 3 renewal periods.

          My principal place of business is in another state as defined by OAR 801-005-0010(43) and I hold an active license in that jurisdiction.

          Print Name
.
          Signature (must also sign certification on page 4)                                                   Date

Questions? Please contact (503) 378-4181 or boa.info@oregon.gov                           2020 CPA/PA Permit Renewal                      P a ge |5
CREDIT/DEBIT CARD PAYMENT AUTHORIZATION FORM
                    *** MUST ACCOMPANY PERMIT RENEWAL APPLICATION IF PAYING BY CREDIT CARD ***

LATE fees MUST be included with applications postmarked on or after July 1, 2020 or received by FAX on or after July 1, 2020. The
postmark must be provided by a USPS or other commercial mail delivery provider. Mailing date stamped by a private postage meter
will not be accepted to establish timely renewal. For your protection, email submissions will not be accepted.

 ACTIVE             $255          INACTIVE               $50            RETIRED              $50         MUNICIPAL               $150
 ACTIVE LATE FEE    $255          INACTIVE LATE FEE      $50            RETIRED LATE FEE     $50         MUNICIPAL LATE FEE      $150

                                           VISA or MASTERCARD ONLY
 CARDHOLDER’S INFORMATION (please PRINT and provide ALL information)
 Charge Amount:                                                                       Visa                             Mastercard

 Card Number:                                                                                      Expiration date:

 Cardholder Name (as it appears on card):

 Cardholder Billing Address:
                                     House number / Street / Apartment number

 City                            State                                Zip Code                         Daytime phone number

 Cardholder’s Signature (unsigned credit card payments will not be processed)                                       Date
   UNSIGNED CREDIT CARDS WILL NOT BE PROCESSED. IF PROPER PAYMENT IS NOT RECEIVED BY THE DUE DATE, YOUR
               RENEWAL APPLICATION MAY BE CONSIDERED LATE AND A LATE FEE MAY BE CHARGED.

                   If paying by CHECK                                            If paying by CREDIT CARD
                  Make check payable to
               Oregon Board of Accountancy                                                 You may mail or fax to

               Mail renewal form and check to:                                              FAX: 503-378-3575

                                                                                      NEW MAILING ADDRESS:
             Oregon Board of Accountancy
                                                                                 Oregon Board of Accountancy
                       Unit 05
                                                                                    200 Hawthorne Ave SE
                     PO Box 4395
                                                                                           Ste D450
               Portland, OR 97208-4395
                                                                                    Salem, OR 97301-5289

    For your privacy and protection, please DO NOT EMAIL renewal applications.

Questions? Please contact (503) 378-4181 or boa.info@oregon.gov                  2020 CPA/PA Permit Renewal                   P a ge |6
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