Form Ftb 4905c C1 - Authorization To Release Financial Information To The Franchise Tax Board

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STATE OF CALIFORNIA
FRANCHISE TAX BOARD
Authorization to Release
Financial Information to
the Franchise Tax Board
I hereby authorize
Name of Financial Institution
located at
Address of Financial Institution
to release to the California Franchise Tax Board financial records in the name(s) of
covering the period from
to
.
One Year Prior to Offer Date
Current Date Plus Six Months
The statutory purpose for which the information is to be obtained is for administration of and compliance with the
California Personal Income Tax and Bank and Corporation Tax Laws. I understand my rights under the California Right
to Financial Privacy Act, and I have been notified that I have the right to revoke this authorization at any time.
This authorization becomes effective on
and expires on
Current Date
.
Current date plus six months
Signature of Taxpayer or Corporate Officer
Signature of Taxpayer or Corporate Officer
FTB 4905C C1 (REV 2-96)

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