Change of Information: Non-License Owners – Alabama State Board of Public Accountancy

Use this form to submit changes of information for individual Non-Licensee Owners (NLO) to the Alabama State Board of Public Accountancy. Please complete the entire form to ensure all of your contact information is up to date.

Name changes cannot be submitted using this form. Changes to your name must be emailed to info.change@asbpa.alabama.gov along with any legal documentation (e.g., copy of a marriage certificate).

NOTE: Submitted changes are not reflected immediately on the online search function.

Date:

NLO #:

Last 4 digits of SSN:

First Name:

Middle Name:

Last Name:

Person submitting information if not the NLO listed above:

Preferred Mailing Address

Line 1:

Line 2:

City:

State:

Zip Code:

Out-of-country address:

Preferred Telephone Number (include area code):

Ext:

Alternate Mailing Address

The information for my Alternate Mailing Address is my:

Email Address:

Fax Number:

CPA/PA Firm:

Job Title:

Ownership %:

Work Time %:

Check this box if you are no longer a Non-Licensee Owner of the above-named CPA/PA firmCheck Box

Comments: