Form Ftb 4925 C2 - Application For Voluntary Disclosure Page 3
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52. Based on the foregoing, how many qualified members are applying to enter the VDP in connection
with the qualified LLC?
a. Number of qualified members that are individuals: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
b. Number of qualified members that are corporations: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
c. Number of qualified members that are LLCs: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
3. State the reason, if any, that any members of the primary LLC applicant are not applying for the VDP:
______________________________________________________________________________________________
4. State the basis the members had for believing that they were immune from California tax: _______________________
______________________________________________________________________________________________
5. Did the members rely upon the advice of a person in a fiduciary position or other competent
advisor 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 that you received the advice: _________________________________________
______________________________________________________________________________________________
6. Provide other information attesting to the qualified members’ good faith and lack of willful neglect
in failing to file California tax returns and pay California taxes: _____________________________________________
______________________________________________________________________________________________
If voluntary disclosure relief is sought for individuals, corporations, and LLCs that held interests indirectly in qualified LLCs
through an interest in an LLC that is a pass-through for tax purposes, attach additional sheets to provide the information
requested above for each entity seeking relief as an indirect owner of an interest in a qualified LLC .
Qualified LLC applicants must also complete Parts 6 through 8 below .
Part 5 – Information Required for Secondary Applicants – Qualified Beneficiaries
1. How many beneficiaries held an interest in the trust?
a. How many beneficiaries are individuals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________
Only beneficiaries who are individuals may enter the VDP .
b. Have all individual beneficiaries applying in connection with this application been California
nonresidents for the past six years? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Individual beneficiaries must be nonresidents on the signing date of the voluntary disclosure
application, and for the prior six years, to be qualified beneficiaries .
2. How many qualified beneficiaries are applying to enter the program? . . . . . . . . . . . . . . . . . . . . . . . . . ______________
3. Please state the reason, if any, that any individual beneficiaries are not applying for the VDP: ____________________
______________________________________________________________________________________________
4. State the basis the beneficiaries had for believing that they were immune from California tax: _____________________
______________________________________________________________________________________________
5. Did the beneficiaries 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 that you received the advice: ____________________________________
______________________________________________________________________________________________
6. Provide other information attesting to the qualified beneficiaries’ good faith and lack of willful
neglect in failing to file California tax returns and pay California taxes: ______________________________________
______________________________________________________________________________________________
Qualified trust applicants must also complete Parts 6 through 8 below .
FTB 4925 c2 (REV 12-2015) PAGE 3
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