Change of Information: Individual CPAs or PAs – Alabama State Board of Public Accountancy

Please complete this form in its entirety 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:

Certification Type:CPAPA

Certificate No.:

Last 4 digits of SSN:

First Name:

Middle Name:

Last Name:

Person submitting information (if not the CPA/PA listed above):

Preferred Mailing Address

Line 1:

Line 2:

City:

State:

Zip Code:

Out-of-country address:

Preferred Telephone Number (include area code):

Ext:

The information for my Preferred Mailing Address is my:Home AddressWork Address

Alternate Mailing Address

Line 1:

Line 2:

City:

State:

Zip Code:

Out-of-country address:

Alternate Telephone Number (include area code):

Ext:

The information for my Alternate Mailing Address is my:Home AddressWork Address

Email Address:

Fax Number:

Employer:

Capacity:

Comments: