Financial Statement-State Of California Form Page 3
Download a blank fillable Financial Statement-State Of California Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Financial Statement-State Of California Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Do you expect changes to income (and/or) health that may change your monthly expenses? If yes, explain:
Have you filed bankruptcy?
YES
NO
If yes, complete the following:
District:
Case Number:
Chapter Number:
Judge’s Name:
Petition Date: ____/____/____ Discharge Date: ____/____/____
Attorney’s Name:
Attorney’s Phone Number:(
) _______-______________
DOCUMENTATION
You must submit the following documentation with your financial statement. Payment arrangements may be delayed
if all required documentation is not included.
1. Verification of income and expenses for the past three months:
• Copies of all pay stubs and statements of any other income.
• Copies of IRS tax payments for delinquent taxes and estimate payments.
• Copies of alimony AND child support payments.
In addition, if self employed:
• Current balance sheet and income statements.
• Annual balance sheets and income/expense statements for the last two years (such as
IRS FORM 1040 Schedule C).
• Current list of accounts receivable (names, addresses, and balance due statements).
• Current list of notes receivable (names, addresses, and balance due statements).
2. Bank information for the past three months:
• Bank statements for all personal and/or business accounts.
3. Tax Returns:
• If you have not filed all required tax returns, you must include them with this request.
4. Other:
• Documentation and explanation of other household expenses that may exceed a reasonable amount.
If we approve your request, we agree to let you pay the tax you owe in monthly installments instead of
immediately paying the amount in full. In return, you agree to make your monthly payments through electronic
funds transfer (EFT). Additional information and instructions about EFT will be sent to you if your payment
arrangement is approved.
Under penalty of perjury, I declare that to the best of my knowledge and belief this statement of assets, liabilities
and other information is true, correct and complete. I understand that a state tax lien may be filed. I also
understand that future state income tax returns must be filed when due and the tax liability paid in full or my
payment arrangement will be cancelled.
TAXPAYER’S SIGNATURE
SPOUSE’S SIGNATURE
DATE
FTB 3561 C2 (REV 7-97) PAGE 3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form De 999c - How To Prepare The Offer In Compromise Financial Statement (de 999b) - State Of California
Legal
Form Bls-700-331 - Collection Agency Board Personal/corporate Financial Statement - State Of Washington
Financial
State Of California Secretary Of State Statement By Foreign Partnership - California Secretary Of State
Legal
State Of California Department Of Education Statement Of Intent To Employ A Minor And Request For Work Permit- Certificate Of Age
Business
Related Categories
Parent category: Financial