Form Ftb 4925 C2 - Application For Voluntary Disclosure
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1
2Application for Voluntary Disclosure
State of California
Franchise Tax Board
Part I
Representative’s or Applicant’s Name ___________________________________________________________________
Representative’s or Applicant’s Address _________________________________________________________________
_________________________________________________________________
Representative’s or Applicant’s Telephone Number (
) _________________________________________________
Representative’s or Applicant’s Facsimile Number (
) _________________________________________________
Part II
. Type of entity applying for the
Voluntary Disclosure Program:
Bank
Corporation
S corporation
S corporation shareholder
Limited Liability Company
Member
Trust
Beneficiary
Single entity doing business inside and outside California
Member of an affiliated group with at least one entity doing
business inside and outside California
LLC member
2. Type of return to be filed:
A separate return apportioning income within and without California
A combined report apportioning income within and without California
3. Tax years to be covered by the agreement: ____________________________________________________________
Part III
.
Is the applicant organized and existing under the laws of the state of California?
Yes
No
2.
Is the applicant qualified or registered with the California Secretary of State?
Yes
No
3.
Does the applicant maintain and staff a permanent facility in California?
Yes
No
4.
Has the applicant or a predecessor ever filed a return with FTB?
Yes
No
5.
Has the applicant ever been the subject of an inquiry by FTB with respect to liability for
income/franchise taxes?
Yes
No
6.
Was any individual applicant a California resident prior to the date of its voluntary
disclosure application?
Yes
No
If you answered “Yes” to any of the above questions, STOP. The applicant does not qualify for the Voluntary Disclosure
Program. If you answered “No” to all six questions, go to Part IV.
FTB 4925 C2 (REV 06-2008) PAGE 3
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