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NT UNDER SUBSTANTIALLY EQUIVALENT STANDARDS Print in ink or type NAME: LAST FIRST MI Ms. Mr. In order to receive a practice privilege under substantial equivalency, your principal place of business must be located in another state and you must hold an active license from that jurisdiction. Please provide the following information regarding your principal office: FIRM/BUSINESS NAME ADDRESS CITY State ZIP CODE DAYTIME PHONE NUMBER Is this a CPA firm? Yes EMAIL No License Number License.

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