California Form 3555 - Request For Tax Clearance Certificate

California Form 3555 - Request For Tax Clearance Certificate - Corporations Page 4

CORPORATION, LIMITED LIABILITY COMPANY, OR LIMITED LIABILITY

PARTNERSHIP ASSUMPTION OF TAX LIABILITY

The Assumption of Tax Liability

of (1) __________________________________________________________ )

)

A corporation

______________________________________________________________ ) ________________________

Corporation no.

)

by (2) _________________________________________________________ )

)

A corporation/limited liability company or limited liability partnership

______________________________________________________________ ) ________________________

Corporation no. or SOS file no.*

incorporated, organized, or qualified to do business within the State of California, unconditionally

agrees to file with the Franchise Tax Board all returns and data that is required and unconditionally

agrees to pay in full all tax liabilities, penalties, interest and fees of (1) __________________

_________________________________________________________________________________;

(2) _________________________________________

Exact corporation, LLC, or LLP name

_________________________________________

Signature and title of officer/manager/partner

State of _______________________________

County of _____________________________

On ________________________________________ before me, the undersigned, a Notary Public in and for

said State, personally appeared ______________________________________________________________

_______________________________________________________________________________________

personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s)

whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they

executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the

instrument the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

Signature ________________________________________________________

Name __________________________________________________________

(typed or printed)

*LLC and LLP assumers must provide a financial statement.

FTB 3555 C1 (REV 11-1999) PAGE 4

California Form 3555 - Request For Tax Clearance Certificate - Corporations Page 4