Form 3555a - Request For Tax Clearance Certificate - Exempt Organizations
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1Request for Tax Clearance
CALIFORNIA FORM
3555A
Certificate — Exempt Organizations
California Identification Number
Corporation Name
Current Address
Phone Number
Federal Employer Identification Number
(
)
Date operations
Date operations
Latest tax year
Date filed:
commenced
ceased or will
for which a California
in California:
cease in California:
return was filed:
We will issue a Tax Clearance Certificate when all taxes are paid or secured. If you have not yet filed a final
return, you must file one.
Notes
1. All public benefit corporations, all religious corporations, and those mutual benefit corporations holding charitable
assets in trust must also obtain a Dissolution Waiver of Notice from the California Attorney General in order to
complete dissolution. For guidance in requesting the waiver, refer to the Attorney General’s publication General
Guide for Dissolving a California Nonprofit Corporation (CT-603). You may view and download the publication on the
Attorney General’s Website at
2. Until the applicable statutes of limitation expire, we may audit your returns and impose additional tax, if warranted,
even though we issued a Tax Clearance Certificate.
Please indicate the status of any IRS activity:
Is the IRS or the FTB currently examining the corporation
Has the IRS changed the corporation’s income tax liability
or has either notified the corporation of a pending
or issued a ruling as to federal income tax exemption for
examination?
any years that you have not reported to us?
Yes
No If yes, indicate the years involved:
Yes
No
Current Examination:
__________________
If yes, send us a copy of the Revenue Agent’s Report.
Pending Examination: __________________
Supplemental information. Please furnish the following information if another corporation will continue to conduct the
business in California after the merger of the original corporation.
Name of Transferee
California Identification Number of Transferee
Current Address
Phone Number
Federal Employer Identification Number
(
)
Date Assets Transferred to Transferee
Section of the Internal Revenue Code applicable to the
transfer of taxpayer’s business or assets:
If we are to mail the Tax Clearance Certificate to someone other than the corporation listed above, please complete the
following: (We will send a copy of the Tax Clearance Certificate to the Secretary of State.)
Name
Address
Phone Number (
)
Mail completed form to:
DOCUMENT FILING SUPPORT UNIT
SECRETARY OF STATE – BUSINESS FILINGS
1500 11TH STREET
SACRAMENTO CA 95814-5701
For more information concerning this form, telephone the Franchise Tax Board at (916) 845-4171.
Assistance for persons with disabilities: We comply with the Americans with Disabilities Act. Persons with hearing or
speech impairments please call TTY/TDD (800) 822-6268.
FTB 3555A C1 (REV 11-2003)
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