California Form 3574 - Special Election For Business Trusts And Certain Foreign Single Member Llcs - 2016

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Special Election for Business Trusts and
CALIFORNIA FORM
TAXABLE YEAR
3574
Certain Foreign Single Member LLCs

Name of entity
California Secretary of State (SOS) file number
DBA
FEIN
Address (suite, room, PO box, or PMB no.)
City
State
ZIP code
If any of the entity’s information has changed, complete the section below.
Name of entity
California Secretary of State (SOS) file number
DBA
FEIN
Address (suite, room, PO box, or PMB no.)
City
State
ZIP code
1 Type of election: (See instructions, General Information A, Purpose).
a  Existing eligible business trust electing to be classified as a partnership (the same as federal).
b  Previously existing foreign single member limited liability company electing to be classified as a disregarded entity (the same as federal).
2 Effective date of election: month ______________ day ______________ year _____________ .
3 Person whom Franchise Tax Board may call for more information:
Name of contact person
Title
Telephone
(
)
Consent Statement and Signature(s)
Under penalties of perjury, I (we) declare all of the following:
• I (We) consent to the election of the above-named entity to be classified as indicated above.
• I am (We are) aware of the filing requirements under Revenue and Taxation Code Sections 18633 and 18633.5 relating to the return filing
requirements for a partnership or a disregarded entity.
• I am (We are) aware that this election is irrevocable.
• I (We) have examined the election and to the best of my (our) knowledge and belief, it is true, correct, and complete.
• If I am an officer, manager, or member signing for other members of the entity, I further declare that I am authorized to execute this consent on their
behalf.
Member’s name (print)
Signature
Title
Date
FTB 3574 2016
7411163

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