Please return this completed form to:
STATE OF CALIFORNIA
FRANCHISE TAX BOARD
PO BOX 942840
SACRAMENTO CA 94240-0040
Or fax to 916.843.0468
Get FTB 1131, Franchise Tax Board Privacy Notice, at ftb.ca.gov or call us at 800.338.0505. If outside the United States,
call 916.845.6500 (not toll-free).
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Internet and Telephone Assistance
Website:
ftb.ca.gov
Phone:
800.852.5711 from within the United States
916.845.6500 from outside the United States (not toll-free)
TTY/TDD:
800.822.6268 for persons with hearing or speech impairments
FTB 4107 C2 (NEW 03-2009) PAGE 2