Form Ftb 3557 A Llc - Application For Certificate Of Revivor
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1
2STATE OF CALIFORNIA
FRANCHISE TAX BOARD
APPLICATION
FOR
CERTIFICATE
OF REVIVOR-
WALKTHROUGH
0 Suspension
0 Forfeiture
0 Restored
DFTB
D Sec. of State
D Revived
Before the California
Franchise Tax Board
In the matter of the application for certificate of revivor o~
Entity Number
FEIN/SOS Number
Entity Name
Address
I request relief from suspension or forfeiture for this entity.
payments, returns, or documents.
have previousl~ submitted or I am enclosing all required
Print Name
Title
Signature
Date
Daytime Telephone Number
Those who can sign this application on behalf of an entity (domestic or for
t ,gn> include:
.Any
stockholder,
creditor,
member,
general
partner,
or officer.
.Any
person having an interest in relief from suspension or forfeitur
.
Domestic entities can also have a majority of the surviving trustees or direftors sign on their behalf.
!
If your entity is exempt under Revenue and Taxation Code section 23775'
j
YOU must include a $10 revivor fee.
The California Secretary of State did not grant your entity's request for evivor or restoration because the name
you requested:
0
Is not available. You must file a "Certificate of Amendment" with t
~
e Secretary of State to change the
name of your entity, and then complete the revivor or restoration
rocess.
0
Is owned by
.This
entity is an existing California or foreign
ntity on file with the California
Secretary of State. The address of record is:
I
To use the name you requested for your entity, you must get a let~er of consent from the above named
entity. Please provide consent on the entity's letterhead with a written authorization from a qualified officer.
Without such consent, you must file a "Certificate of Amendment" ~ith the Secretary of State to change the
name of your entity, and then complete the revivor or restoration ~rocess.
FTB 3557 A LLC (NEW 03-2003)
Page 1
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