Power Of Attorney
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STATE OF CALIFORNIA
POWER OF ATTORNEY
FRANCHISE TAX BOARD
PO BOX 2828
DECLARATION FOR THE FRANCHISE TAX BOARD
RANCHO CORDOVA CA 95741-2828
FAX NUMBER: (916) 845-0523
This Power of Attorney Declaration remains in effect until you resolve the matters specified on it, or until you
revoke it.
We provide instructions for completing this form on pages 3 and 4. For more information about a power of attorney, visit
, then type POA in the Search field. Or see publication Power of Attorney (FTB 1144).
1. Taxpayer information – Complete in full to avoid delays.
Taxpayer’s Name and Address – Personal or Business
Social Security #:
Business Entity Identification #:
1
(If this is a joint power of attorney, include your spouse/RDP’s
name and address)
-
-
CA Corp #:
-
-
SOS #:
Daytime Telephone #:
Check if new
FEIN:
address
(
)
-
Spouse/RDP’s address, if different
Note: You must complete and attach page 5 if this power of attorney applies to the combined reporting of
multiple corporations.
2. The taxpayers listed above appoint the following representatives as attorneys-in-fact:
Name and Address
Primary Representative
IRS CAF #:
PTIN:
Telephone #:
(
)
-
Fax #:
(
)
-
Check if new
Address
Telephone #:
Name and Address
IRS CAF #:
PTIN:
Telephone #
(
)
-
Fax #:
(
)
-
Check if new
Address
Telephone #:
Note: Attach a list of additional representatives if necessary.
3. Specific issues, tax years, or income periods
The representatives listed can represent you before us for the following:
Tax Years (required): ___________________________________________________________________________
Matters (optional): _____________________________________________________________________________
4. Authorization only for information
Check this box if you only authorize your representative to receive your confidential tax information, but not to act
as your attorney-in-fact.
5. Acts authorized
You authorize your representative as an attorney-in-fact to:
• Receive and inspect your confidential tax information.
• Perform any actions you might perform to resolve your issues with us – such as signing agreements, consents, or
other documents.
The authority granted does not include the power to receive refund checks, the power to substitute another
representative, or the power to sign certain tax returns – unless you specify otherwise in section 6.
1
RDP refers to a registered domestic partner or partnership.
FTB 3520
(REV 11-2007) Page 1
C1
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