Ftb 3520 C1 - Power Of Attorney - Declaration For The Franchise Tax Board - 2010

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CFS
STATE OF CALIFORNIA
Power of Attorney
POA UNIT MS F283
FRANCHISE TAX BOARD
Declaration for the Franchise Tax Board
PO BOX 2828
RANCHO CORDOVA CA 95741-2828
This Power of Attorney (POA) Declaration remains in effect until you revoke it.
We provide instructions for completing this form on PAGES 3 and 4. For more information about a POA, go to ftb.ca.gov
and search POA.
1. Taxpayer Information (Complete in full to avoid delays)
Taxpayer's Name and Address - Personal or Business
Social Security No:
Business Entity Identification No:
1
If this is a joint POA, include your spouse/RDP name and
address. Check if new address
.
CA Corp No:
SOS No:
Daytime Telephone
FEIN:
Spouse/RDP's address, if different:
You must complete and attach PAGE 5 if this POA 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 No:
PTIN:
Telephone :
Fax :
Check if new
Address
Telephone
Name and Address
IRS CAF No:
PTIN:
Telephone:
Fax :
Check if new
Address
Telephone
Attach a list of additional representatives; see PAGE 6 for your use, if necessary.
3. Specific Matters, Tax Years, or Income Periods
The representatives listed can represent you before us for the following:
Tax Years or Income Periods (required):
Matters (optional):
4.
Authorization for Information Only
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.
1
RDP refers to a registered domestic partner or partnership.
FTB 3520 C1 (REV 12-2010) PAGE 1

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