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 November 30, 2011 and January 13, 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 for at least 15 consecutive years and have averaged 50 or more tax returns prepared during this period. I am forwarding the Application of Waiver from the Maryland Tax Preparers Examination to the Board. 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:


Re-type Full Name:



, -
County:


    



- - (MM-DD-YYYY)
Place of Birth:

and : ,

:         
:

- -

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?
2. Had this type of license, certificate, registration, or permit denied, suspended, or revoked by Maryland or any other jurisdiction?

 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, Licensing and Regulation 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, Licensing and Regulation 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, Licensing and Regulation 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 user 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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