Form Ftb 4092 C3 - Filing Application For First-Time Filers On Cartridge, Cd, Or Diskette - 2008

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STATE OF CALIFORNIA
DATA EXCHANGE MS L120
Filing Application
FRANCHISE TAX BOARD
For first time filers on cartridge,
PO BOX 1468
CD, or diskette.
SACRAMENTO CA 95812-1468
916.845.3778
Application is hereby made to transmit annual 1098/1099/5498/W-2G information returns to Franchise Tax Board.
Name of Firm (Transmitter):
Date:
/
/
Address:
Federal Employer Identification Number:
–
City, State, and ZIP Code:
Reporting will begin with
Tax Year:
Contact for Technical Information (Name):
Title:
Telephone (Area Code & Ext.)
.
.
.
REPORTING INFORMATION
Please indicate the document type(s) you plan to file on cartridge, diskette, or CD.
 1098
 1099
 5498
 W-2G
Do you plan to act as a transmitter for other Payers?
 Yes
 No
MEDIA PREFERENCE
 CARTRIDGE
 CD
 DISKETTE
NOTE: 4mm or 8mm cartridges, and 9-track tape reels are not acceptable.
AUTHORIZED REPRESENTATIVE OF ORGANIZATION REQUESTING APPROVAL
Name (Type or Print):
Title:
Signature:
Date:
Note: This completed form can be faxed to:
Data Exchange
916.845.5550
FTB 4092 C3 (REV 11-2008)

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