USVI Public Records

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AT THE TIME OF APPLICATION, submit fees and a personal statement as noted below: Fees (all apply) □ Reinstatement Application Fee $250 □ Delinquent Fee $25 per month (Maximum $600) □ Renewal License Fee Annual fee for each year of delinquency A personal statement explaining the reason for the inactive status. Please check all that apply. □ Illness □ Other good cause □ Unusual Hardship to include health,, military service, foreign residence Note: At least one box must be checked. SUBSEQUENT TO BOARD APPROVAL OF APPLICATION, Please submit the following: CPE reporting Form DLCA CPA 100 - STEP 1 : Reinstates inactive to delinquent Submit certificates of completion for 120 CPE hours to include: □ 30 hours in accounting and auditing □ 4 hours in board approved ethics □ No more than 30 hours in behavioral subjects CPE reporting Form DLCA CPA 100 - STEP 2: Reactivates delinquent license to current active Submit certificates of completion for 120 CPE hours to include: □ 30 hours in accounting and auditing □ 4 hours in board approved ethics □ No more than 30 hours in behavioral subjects Note: CPE courses used for Step 1 cannot be used for Step 2. Please mail your completed application, personal statement, and fees to: VI Board of Public Accountancy VI Board of Public Accountancy Department of Licensing and Consumer Affairs Department of Licensing and Consumer Affairs 3000 Golden Rock Shopping Center, Suite 9 Property Procurement Bldg. No.1 Subbase St. Croix, VI 00820-4311 St. Thomas, VI 00802 Requirements for Reinstatement and Reactivation Continuing Professional Education (CPE) hours are required for reinstatement (Step1) and for reactivation (Step 2): Submit required CPE hours on the CPE reporting Form DLCA CPA 100 and submit certificates of completion. APPLICATION CHECKLIST US Virgin Islands Board of Public Accountancy Application for Reinstatement of Delinquent License Form DLCA CPA 120 (2022 ) US Virgin Islands Board of Public Accountancy Application for Reinstatement of Delinquent License Form DLCA CPA 120 (2022 ) Select the Action Requested Reinstate inactive license □ Unusual hardship resulting in the inactive status □ Illness resulting in the inactive status Note: An explanation other than unusual hardship or illness is not applicable for consideration APPLICANT INFORMATION FULL LEGAL NAME Social Security Number MAILING ADDRESS CONTACT INFORMATION BACKGROUND QUESTION □ Yes □ No If you answer yes to the following question, you must complete the Explanation of Criminal Background question section (attach additional pages if needed). This question applies to any criminal violation of the laws of any state, nation or territory, including felony, misdemeanor and traffic offenses (but not parking, speeding, inspection or traffic signal violations), without regard to whether you were placed on probation, had adjudication withheld, were paroled, or pardoned. If you intend to answer "NO" because you believe those records have been expunged or sealed by court order, you are responsible for verifying the expungement or sealing prior to answering "NO". Your answer to this question may be checked against local, state and federal records. Failure to answer this question accurately may result in the denial, or revocation of your license. If you do not fully understand this question, consult with an attorney or contact the department. Since the filing of the initial licensure application or endorsement application, have you ever been convicted or found guilty of, or entered a plea of guilty, regardless of adjudication, to a crime in any jurisdiction, or are you currently under criminal investigation? Zip Code Last Name First Middle Permit/License Number Street Address or PO Box Date of Birth Residence Phone Number Business Phone Number EMAIL ADDRESS State City US Virgin Islands Board of Public Accountancy Application for Reinstatement of Delinquent License Form DLCA CPA 120 (2022 ) EXPLANATION OF CRIMINAL ACTIVITY - Please attach any documentation that may aide in decision making Have all sanctions been satisfied? □ Yes □ No EXPLANATION OF CRIMINAL ACTIVITY - Please attach any documentation that may aide in decision making Have all sanctions been satisfied? □ Yes □ No AFFIRMATION BY WRITTEN DECLARATION Date of Offense (MM/DD/YYYY) Penalty/Disposition State/Nation/Territory Offense I understand that my signature on this written declaration has the same legal effect as an oath or affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts stated in it are true. I understand that falsification of any material information on this application may result in criminal penalty or administration action, including a fine, suspension or revocation of the license. Signature Date Print Name Penalty/Disposition Date of Offense (MM/DD/YYYY) Description - Provide a copy of the arrest report, final judgement or other legal documents pertinent to criminal activity. Description - Provide a copy of the arrest report, final judgement or other legal documents pertinent to criminal activity. Offense State/Nation/Territory US Virgin Islands Board of Public Accountancy Application for Reinstatement of Delinquent License Form DLCA CPA 120 (2022 ) AFFADAVIT State of Territory of Country I, _____________________________, being duly sworn, depose and say that I am the person who (print name) executed the foregoing instrument; that I have read the same and know the contents thereof; that the matters stated therein are true to my knowledge; that I have not suppressed any information that might affect this application; and that I have read and understand this affidavit. Applicant's Signature Sworn and subscribed before me this _______day of ____________________, 20 ____. SEAL _______________________________ Notary Public My Commission expires on _________ Board Disposition Application Approved: ( _____) YES ( _____) NO Signature, Chairman of the Board Date Member Member Member Member Member (Must be completed by all applicants) Do not write below this line: