|State of Maryland Department of Labor, Licensing and
Maryland State Board Of Public Accountancy
500 N. Calvert St., Room 308
Baltimore, Maryland 21202-3651
(410) 230-6322 (Baltimore area), (888) 218-5925 (Toll Free)
|I.||Candidate must complete this section (please type):
City , State Zip Code
Daytime Telephone No.
I, , am applying for a Limited License to the State of Maryland, based upon my
By the State of .
Note to applicants: Upon completion of Section I, please forward this form to the state board from which you obtained your original license. Include a postage paid, addressed envelope for return to the Maryland Board.
|II.||THIS SECTION MUST BE COMPLETED BY THE STATE BOARD FROM WHICH YOU OBTAINED THE
ORIGINAL LICENSURE (please circle the appropriate answer).