Form Ftb 3570 - Waiver Extending Statute Of Limitations For Proposing Deficiency Assessments

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STATE OF CALIFORNIA
FRANCHISE TAX BOARD
PO BOX 2487
SACRAMENTO
CA 93303-2487
TELEPHONE:
(916)
WAIVER EXTENDING STATUTE OF LIMITATIONS
FOR PROPOSING DEFICIENCY ASSESSMENTS
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Taxpayer(s)
Corporate Number
Return(s) for income years ended
Statute of limitations extended to
The taxpayer(s) named above consent(s) and agree(s) that the amount of any deficiency in taxes or penalties,
including interest, due under any return(s) made by or on behalf of the taxpayer(s) for the year(s) indicated may
be proposed to be assessed at any time on or before the extended date shown above.
The signing and acceptance of this consent will automatically result in an extension of the period within which a
claim for refund may be filed if such period has not expired prior to the filing of this consent.
Date
TAXPAYER
Date
TAXPAYER
SIGNATURE OF OFFICER
TITLE
NOTE: A corporate waiver must be signed by a principal officer or duly authorized agent. An individual's
signature above shall be prima-facie evidence that such individual is authorized to sign this waiver on
behalf of the corporation.
Waivers signed by a representative or an attorney-in-fact must be accompanied by a completed power of
attorney authorizing such signature.
You are not required to agree to this extension of time for assessment. You may refuse to grant any
extension or you may agree to an extension for a limited period of time:. If you choose either of these
options, we may issue a proposed assessment based on information available to us. If you choose to
change the extension date, please contact us for a revised statute waiver form.
FTB 3570 (REV 12-2000)

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