Form Ftb 6274 C3 - Waiver Request From Filing Information Returns Electronically
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STATE OF CALIFORNIA
DATA EXCHANGE MS L120
FRANCHISE TAX BOARD
PO BOX 1468
SACRAMENTO CA 95812-1468
916.845.3778
Waiver Request From Filing Information Returns Electronically
Firm Name:
Date:
/
/
Mailing Address:
Federal Employer Identification Number:
–
City/State/ZIP Code:
Waiver Request for
Tax Year:
Contact Name:
Title:
Telephone Number:
.
.
.
1098
1099
5498
W-2G
1. This waiver request is for the following returns:
Anticipated volume, all returns: _________________
If other, please identify types: _____________________________________________________________________
2. Is this the first year you have submitted a waiver request?
Yes
No
3. Reason for your waiver request: __________________________________________________________________
____________________________________________________________________________________________
4. Have you been granted an IRS waiver?
Yes
No
Approved waiver requests are valid only for the tax year indicated. Subsequent tax year waivers must be filed separately
on form FTB 6274 or the federal equivalent. If this waiver is approved, the applicable paper return copies must be filed
with us by the filing due date of May 31 for Form 5498 and February 28 for all other information returns. If the correspond-
ing due date falls on a Saturday, Sunday, or legal holiday, the due date is extended to the next business day.
I declare that I have examined this form, including any accompanying statements, and, to the best of my knowledge
and belief, it is true, correct, and complete.
Signature:
Title:
Date:
/
/
Note: This completed form can be faxed to:
Data Exchange
916.845.5550
FTB 6274 C3 (REV 10-2009)
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