California Form 3537 (Llc) - Payment For Automatic Extension For Llcs - 2011 Page 2

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DETacH HErE

if no PaYmEnT iS DUE or PaiD ElEcTronicallY, Do noT mail THiS form

DETacH HErE

limited liability company name

Secretary of State (SoS) file number

fEin

Nonresident member(s) that did not sign form FTB 3832:

Taxable Year 2011

(a)

(b)

(c)

(d)

(e)

(f)

(g)

Member’s name

SSN, ITIN, or FEIN

Distributive

Tax

Member’s

Amount withheld by this

Member’s

share of income

rate

total tax due

LLC on this member –

net tax due

(see instructions)

reported on Form 592-B

Total members tax due. Enter this amount on Side 1, Amount of payment (This is the amount you expect to enter on

Form 568, Side 1, line 4). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Attach additional sheets if necessary

Side 2 FTB 3537 2011

6122113