State of Maryland Department of Labor, Licensing And Regulation
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)

Verification of Licensure Form for Limited License

Corporation / Partnership / LLP / LLC



I. Applicant must complete this section (please type):

Name
Address
City   , State   Zip Code
Daytime Telephone No.
Email Address


I, __, am applying for a

Limited Permit for a Corporation / Partnership / LLP / LLC to the State of Maryland on behalf of the firm __, based upon my Firm's
License number: __
Date Issued: __
By the State of: _._


_
Signature


Note to applicants: Upon completion of Section I, please forward this form to the state board from which your firm obtained its 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 YOUR FIRM OBTAINED THE ORIGINAL CERTIFICATION (please circle the appropriate answer):


  1. Is the firm's license in good standing? [ Yes ] [ No ]

  2. Are the License number and date of issue correct? [ Yes ] [ No ]

  3. Date of expiration of license: _




Board Seal Signature _

Title _

Date _