Form Ftb 621 C2 - Voluntary Compliance Initiative 2 (Vci 2) Participation Agreement (Business Entities)

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Voluntary Compliance Initiative 2 (VCI 2)
Participation Agreement
(Business Entities)
Refer to instructions for more information. This serves as the official agreement with the Franchise Tax Board when an authorized
representative completes and signs this form.
For calendar year _____, or fiscal year beginning month _____ day ____ year _____, and ending month _____ day _____ year _____.
Business entity name as shown on income tax return:
California Business Entity Number:
Key Corporation Number (If original tax return was
Current address:
included in an election to file a Unitary Taxpayers’
Group return, include a copy of the Schedule R-7):
Agreement
I understand if I sign this Participation Agreement on behalf of the above-named business entity, and complete the requirements of
VCI 2; the business entity waives its right to protest, appeal, or file a claim for refund or credit for any amounts paid under VCI 2. I also
understand that the Franchise Tax Board (FTB) will cancel the business entity’s VCI 2 agreement if it does not file the required amended
income tax return and pay any resulting tax and interest by October 31, 2011, or enter into an installment agreement that extends the
final payment due date to no later than June 15, 2012. I further understand that FTB may inquire into facts and circumstances related
to the abusive tax avoidance transactions (ATATs) and/or offshore financial arrangements (OFAs) that the business entity used to
underreport its tax liabilities for the tax year for which it participates in VCI 2, and if the business entity fails to cooperate fully with these
inquiries, the waiver of penalties under VCI 2 will be null and void and FTB will impose all applicable penalties.
Please indicate which of the following are reported on the business entity’s amended income tax return (check all that apply):
Reversed ATAT
Unreported income from OFA
Changes not related to ATAT/OFA
Changes based on federal
settlement/closing agreement
Payment of the tax and interest is by (check all that apply):
Check/Money Order
Web Pay Tax Deposit initiated on ______/______/______
Electronic Funds Transfer (EFT) initiated on ______/______/______
Existing Tax Deposit of $____________________ made on ______/______/______ to be applied as payment of tax and interest.
Installment Agreement (complete and attach FTB 9310D and make first installment payment)
See instructions for further details before making your payment.
Attach this agreement to the business entity’s VCI 2 amended income tax return. If the business entity previously filed an amended
income tax return eliminating an ATAT or reporting OFA income, attach a copy of the amended income tax return and indicate the date it
was filed: ______/______/______
Sign Here
Under penalty of perjury of the laws of the state of California, I declare that I examined this form, including any accompanying statements, and to the
best of my knowledge and belief it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which
preparer has any knowledge. I am properly authorized to execute this form.
Name of officer or general partner (please print): _____________________________________
Title: ________________________
Signature of officer or general partner: _____________________________________________
Date: ______/______/______
.
.
Telephone number: ____________________________
A Participation Agreement signed by a representative or an attorney-in-fact must be accompanied by a completed FTB 3520, Power
of Attorney, authorizing such signature. For taxpayers that elected to file a Unitary Taxpayers’ Group return; see How to Participate
instructions.
FTB 621 c2 (REV 08-2011) PAGE 1

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