Form Ftb 4925 C2 - Application For Voluntary Disclosure Page 2
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5Specific Entity Directions
Corporation defined in Section 23038
Complete Parts 6 through 8 . If more than one corporation in a single unitary combined reporting group wishes to
apply for voluntary disclosure relief, each corporation seeking relief must file a separate application, simultaneously
if possible .
S corporation defined in Section 23800
Complete Part 3 for qualified shareholders, in addition to Parts 6 through 8 .
LLC not classified as a corporation
Complete Part 4 for qualified members, in addition to Parts 6 through 8 .
Trust
Complete Part 5 for qualified beneficiaries, in addition to Parts 6 through 8 .
Part 3 – Information Required for Secondary Applicants - Qualified Shareholders
1. How many shareholders held an interest in the S corporation during the years to be covered
by the voluntary disclosure application? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
a. How many of those shareholders are individuals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
Only shareholders who are individuals may enter the VDP .
b. Are all individual shareholders applying in connection with this application currently
California nonresidents? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Individual shareholders must be also nonresidents on the signing date of the voluntary disclosure
application to be qualified shareholders .
2. Based on the above information, how many qualified shareholders are applying for the VDP in
connection with the qualified S corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
3. State the reason, if any, that any shareholders of the primary S corporation applicant are not
applying for the VDP: _____________________________________________________________________________
4. Will the S corporation be filing a group nonresident return (See FTB Pub . 1067)? . . . . . . . . . . . . . . .
Yes
No
5. State the basis the qualified shareholders had for believing that they were immune from California tax: _____________
______________________________________________________________________________________________
6. Did the qualified shareholders rely upon the advice of a person in a fiduciary position or other
competent advice that they were immune from California tax? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If so, describe the nature of the advice you received, status and competency of the person giving
the advice, and the approximate date you received the advice: _____________________________________________
______________________________________________________________________________________________
7. Provide other information attesting to the qualified shareholders’ good faith and lack of willful neglect
in failing to file California tax returns and pay California taxes: _____________________________________________
______________________________________________________________________________________________
Qualified S corporation applicants must also complete Parts 6 through 8 below .
Part 4 – Information Required for Secondary Applicants - Qualified Members
1. How many members held an interest in the LLC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
a. Of that amount, how many are individuals, corporations, and other LLCs? . . . . . . . . . . . . . . . . . . ______________
b. Are all individual members that are applying for relief in connection with this application
currently California nonresidents? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Individual members must also be nonresidents on the signing date of the voluntary disclosure
application to be qualified members .
c. Are all corporations or LLCs that are applying for relief in connection with this
application not: organized under the laws of California; qualified or registered with the
California Secretary of State? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Corporate or LLC members may not enter the VDP if they are organized under the laws of
California, or qualified or registered with the California Secretary of State .
FTB 4925 c2 (REV 12-2015) PAGE 2
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