Form Ftb 3513 - Affidavit For California Income Tax Return Information
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AFFIDAVIT FOR CALIFORNIA
INCOME TAX RETURN INFORMATION
Please see instructions on side 2.
1.
Taxpayer information
Taxpayer’s Name or Corporation’s Name
Social Security or Corporation ID Number
Tax Year
Street Address
City
State
ZIP
2.
Associated business entities
FTB USE ONLY
Business Entity
Address
DLN
Gross Receipt
3.
Information requested from return
Information Requested
Justification
Tax Year
Note: We will provide only "gross receipt" information unless you request other information in section 3, and complete the declaration
in section 4.
4.
Declaration
I,
declare that I am
for
(NAME)
(TITLE)
. The information requested under Revenue and Taxation Code
(CITY, COUNTY)
Section 19551 relates to my current investigation of the tax specified in Chapter
of the
. I will only use the information in the ordinary performance of my
(CITY, COUNTY ORDINANCE)
official duties as an administrator of the city and county ordinance section specified above. I will provide the affected
taxpayer with a copy of this affidavit, and upon request, I will make the information obtained available to the taxpayer.
I declare, under penalty of perjury, that the foregoing is true and correct.
Signature of Requester
Date executed
Location
Telephone
(
)
-
Attention:
Mailing Address
City
State
ZIP
NOTICE
The requested document and all attachments are confidential. Any disclosure or use of any information for purposes
not authorized by law is illegal and will subject the person or agency making the disclosure to criminal prosecution.
FTB 3513 C1 (REV 12-2008) SIDE 1
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