Waiver Form For Extending Statute Of Limitations For Proposing Deficiency Assessments

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STATE OF CALIFORNIA
FRANCHISE TAX BOARD
PO BOX 2487
SACRAMENTO CA 93303-2487
TELEPHONE: (916)
WAIVER EXTENDING STATUTE OF LIMITATIONS
FOR PROPOSING DEFICIENCY ASSESSMENTS
In reply refer to:
r---
1
Taxpayer(s)
Account Number
Personal Income Tax Year(s)
Statute of limitations extended to
We request your approval to extend the statute of limitations for the tax year return(s) shown above. Your
signature(s) will extend the period during which the Franchise Tax Board may examine the return(s) and issue
Notice(s) of Proposed Assessment. The period during which a claim for refund may be filed, or a refund allowed,
will be extended if such period has not expired prior to the filing of this form. If our examination finds that too little
tax was paid, the Notice(s) of Proposed Assessment will state the amount underpaid. Penalties and interest may
be added to the amount of underpayment.
If this waiver extends the claim for refund period, and we find that too
much tax was paid, refund(s) will be issued.
Your agreement to this extension will not affect your protest and appeal rights.
This form must be signed by both spouses or their authorized representative if joint personal income tax returns
were filed. A power of attorney must be sent with this form if it is signed by attorney-in-fact or by the taxpayer's
representative.
You are not required to agree to this extension of time for assessment. You may refuse to grant any extension or
you may agree to an extension for a limited period of time. If you choose either of these options, we may issue a
proposed assessment based on information available to us. If you choose to change the extension date, please
contact us for a revised statute waiver form.
Taxpayer Signature
Date
Date
Taxpayer Signature
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Representative
ii,
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Date

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