Application Form For Certificate Of Revivor - Walk Through

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STATE OF CALIFORNIA
FRANCHISET AX BOARD
APPLICATION
I=OR
CERTIFICATE OF RE:VIVOR-
WALKTHROUGH
D Suspension
D Forfeiture
D Restored
DFTB
DSec.
of State
D Revived
Before the California
Franchise Tax Board
In the matter of the application for certificate of revivor of:
Entity Number
FEIN/SOS Number
Entity Name
Address
I request relief from suspension or forfeiture for this entity. I have previously submitted or I am enclosing all required
payments, returns, or documents.
Print Name
Iitie
Signature
uate
Daytime Telephone Number
Those who can sign this application on behalf of an entity (domestic or foreign) include:
.Any
stockholder, creditor, member, general partner, or officer.
.Any
person having an interest in relief from suspension or forfeiture.
Domestic entities can also have a majority of the surviving trustees or directors sign on their behalf.
If your entity is exempt under Revenue and Taxation Code section 23775, you must include a $10 revivor fee.
The California Secretary of State did not grant your entity's request for revivor or restoration because the name
you requested:
0
Is not available. You must file a "Certificate of Amendment" with the Secretary of State to change the
name of your entity, and then complete the revivor or restoration process.
0
Is owned by
.This
entity is an existing California or foreign entity on file with the California
Secretary of State. The address of record is:
To use the name you requested for your entity, you must get a letter of consent from the above named
entity. Please provide consent on the entity's letterhead with a written authorization from a qualified officer.
Without such consent, you must file a "Certificate of Amendment" with the Secretary of State to change the
name of your entity, and then complete the revivor or restoration process.
FTB 3557A BC (NEW 03-2003) PaQe 1

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