Form Ftb 4800 Meo - Federally Tax-Exempt Non-California Bond Interest And Interest-Dividend Payment Information Media Transmittal Page 3
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1
2
3Federally Tax-Exempt Non-California Bond Interest
PROGRAM LIAISON TEAM MS F310
FRANCHISE TAX BOARD
and Interest-Dividend Payments
PO BOX 1998
RANCHO CORDOVA CA 95741-1998
Hard Copy Reporting Form
Payer Information
FEIN:
Name:
Street:
City:
State:
Payment Year:
ZIP Code:
Payee Information
For more information on privacy and disclosure, get FTB 1131, Franchise Tax Board Privacy Notice, at ftb.ca.gov.
1. SSN:
7. Amount Earned:
2. Name:
8. Acct. No.:
3. Street:
9. Fund Distribution Percentage:
4. City:
10. CUSIP No.:
5. State:
CUSIP Description:
6. ZIP Code:
1. SSN:
7. Amount Earned:
2. Name:
8. Acct. No.:
3. Street:
9. Fund Distribution Percentage:
4. City:
10. CUSIP No.:
5. State:
CUSIP Description:
6. ZIP Code:
1. SSN:
7. Amount Earned:
2. Name:
8. Acct. No.:
3. Street:
9. Fund Distribution Percentage:
4. City:
10. CUSIP No.:
5. State:
CUSIP Description:
6. ZIP Code:
1. SSN:
7. Amount Earned:
2. Name:
8. Acct. No.:
3. Street:
9. Fund Distribution Percentage:
4. City:
10. CUSIP No.:
5. State:
CUSIP Description:
6. ZIP Code:
1. SSN:
7. Amount Earned:
2. Name:
8. Acct. No.:
3. Street:
9. Fund Distribution Percentage:
4. City:
10. CUSIP No.:
5. State:
CUSIP Description:
6. ZIP Code:
Mail to:
PROGRAM LIAISON TEAM MS F310
Person to contact regarding this report:
FRANCHISE TAX BOARD
Name:
PO BOX 1998
RANCHO CORDOVA CA 95741-1998
Telephone: (
)
-
Ext.
Email Address:
FTB 4800 MEO (REV 10-2011) PAGE 5
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