Form Ftb 4107 C2 - Mandatory E-Pay Election To Discontinue Or Waiver Request
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STATE OF CALIFORNIA
Franchise Tax Board
PO BOX 942840
SACRAMENTO CA 94240-0040
Mandatory e-pay Election to Discontinue or Waiver Request
For tax years beginning on or after January 1, 2009, California Revenue and Taxation Code Section 19011.5 requires
taxpayers to remit all tax payments electronically when their estimated tax or extension payments exceed $20,000 or their
total tax liabilities exceed $80,000. Failure to comply with this requirement will result in the assessment of a penalty.
Section 19011.5 provides that any taxpayer who is required to pay electronically may request a waiver of that requirement
(see below for waiver criteria). Complete and mail or fax this form to request a waiver from mandatory e-pay. You must pay
electronically until we notify you we granted your waiver request.
Name
Social Security Number
Spouse’s/RDP’s Name
Social Security Number
Address
City
State
Zip Code
m
I elect to discontinue making payments electronically because I have not made an estimated tax or extension payment
in excess of $20,000 during the current or previous taxable year, or my total tax liability for the current or previous
taxable year did not exceed $80,000.
m
I request a waiver from the mandatory e-pay requirement because the amounts paid were not representative of my
total tax liability, as explained below. (Use the second page of this form if additional space is needed.)
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___________________
______________________________________
_________________________
Date
Signature
Telephone Number
___________________
______________________________________
_________________________
Date
Spouse’s/RDP’s Signature
Telephone Number
FTB 4107 C2 (NEW 03-2009) PAGE 1
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