State Board of Individual Tax Preparers - Individual Tax Preparer Original Application

Preparer Tax Identification Number (PTIN):	P

Expiration Date of PTIN (must be after today�s date):	/ /

IMPORTANT NOTE: Your Preparer Tax Identification Number (PTIN) that is issued by the Internal Revenue Service (IRS) expires at the end of each year. Once you approach 30-days of the expiration of your PTIN expiration date listed above, you will be required to provide an IRS renewal certificate to the board in order that shows you hold a current PTIN. An email notification will be sent by the board to the email address you provide in this application. If you have a new PTIN Expiration to provide, please do so immediately to update your record. You may not conduct business without a current PTIN expiration date.

I am applying for registration as a tax preparer under one of the following options:

Option 1 - I have passed the Maryland Individual Tax Preparers Examination to meet the examination requirement to be issued a registration.

Option 2 - I passed the Registered Tax Return Preparer (RTRP) Examination that was administered by the U.S. Internal Revenue Service (IRS) between January 1, 2010 and January 18, 2013. I am forwarding a copy of the RTRP certificate that I received from the IRS to the Board. Click here for RTRP Examination Confirmation Sheet.

Option 3 - I have prepared federal and state income tax returns consecutively for the past 15 years (from the date of this application), have averaged 50 or more tax returns prepared during this period, and have completed 8 hours of annual continuing education for the last 3 years (from the date of this application). I am forwarding the Application for Waiver of the Maryland Tax Preparers Examination to the Board. Please note that experience providing tax returns for compensation in Maryland after December 31, 2015 does not qualify for use for this option. Only the lawful experience obtained in another state or for no compensation, as described above, may qualify for this option. Click here for 15 year experience waiver application.

Please note, if the Board does not approve your application under Option 2 or Option 3, you will be notified that you will be required to take the Maryland Individual Tax Preparers Examination before you can be issued a registration.

Full Name:	(First)	(Middle)	(Last)
Re-type Full Name:	(First)	(Middle)	(Last)

	I have a United States mailing address
	Address:
	City, State Zip:	, -
	County:
	I have a mailing address outside the United States
	Address:

US Social Security Number:
Re-Type US Social Security Number:

Date of Birth:

- - (MM-DD-YYYY)

Place of Birth:

	I was born in the United States City and State: ,
	I was born outside the United States City: Country:

Daytime Phone
Number:

- -

Personal E-mail address:

Re-type Personal E-mail address:

Business E-mail address:

Re-type Business E-mail address:

You may, if you so choose, use the same email address in both fields presently designated for �Business Email Address� and �Personal Email Address�. However, please note that your business address may be released upon the request from a third party. Your personal email address will only be used for the purposes of communications from DLLR. In addition, if you wish to omit your business email address from the lists of licensees that from time to time DLLR makes available to third parties, you must notify us in writing or you can opt out by leaving your business email address blank. You may send your Opt out notice to dlopl-dllr@maryland.gov

Education: Please indicate all levels completed.


A.	Secondary Education:	High School Diploma	GED

B.	Higher Education:	Undergraduate Degree	Graduate Degree

Have you ever:

1.	Been convicted of a felony or misdemeanor in any State or Federal Court?	Yes	No
2.	Had this type of license, certificate, registration, or permit denied, suspended, or revoked by Maryland or any other jurisdiction?	Yes	No

I have Workers Compensation Coverage Policy/Binder No.

Issued by the

I am not an employer required to provide employee coverage under the Workers Compensation Law.

Certification

By pressing "Submit" below:

I hereby certify, under penalty of perjury, that the information contained herein is true and correct to the best of my knowledge, information, and belief. I further authorize the release of any information contained within this application to an authorized representative of the Department of Labor for further investigation. I further certify that I have paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Department of Labor or have provided for payment in a manner satisfactory to the unit responsible for collection.

In accordance with Executive Order 01.901.1983-18, the Department of Labor is required to advise you as follows regarding the collecting of personal information: Personal information requested by the licensing agency of the Department is necessary in determining your eligibility for licensure. Such personal information is also intended for use as an additional means of verifying the licensee�s identity or to enable the agency to communicate, in a timely manner, with the licensee should the need arise. The licensee has a right to inspect his/her personal record and to amend or correct the personal data if necessary. Personal information is generally available for inspection by the public only in accordance with the Public Information Act. Personal information is not routinely shared with state, federal or local government agencies.

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