Form Ftb 3520 - Power Of Attorney - Declaration Of Administration Of Tax Matters - 1999
ADVERTISEMENT
1
2
3STATE OF CALIFORNIA
POWER OF A
POWER OF ATT
POWER OF A
TT
TTORNEY
TT
ORNEY
ORNEY
ORNEY
For FTB Use Only:
POWER OF A
POWER OF A
TT
ORNEY
FRANCHISE T
FRANCHISE T
AX BOARD
AX BOARD
FRANCHISE T
FRANCHISE TAX BOARD
FRANCHISE T
AX BOARD
AX BOARD
Corr: _____________________
DECLARA
DECLARATION FOR
DECLARA
TION FOR
TION FOR
TION FOR
DECLARA
DECLARA
TION FOR
PO BOX 2828
Phone: ____________________
RANCHO CORDOVA CA 95741-2828
ADMINISTRA
ADMINISTRA
TION OF
TION OF
ADMINISTRA
ADMINISTRATION OF
ADMINISTRA
TION OF
TION OF
Fax Number (916) 845-0523
Follow-up: _________________
T T T T T AX MA
AX MA
AX MA
AX MA
AX MATTERS
TTERS
TTERS
TTERS
TTERS
Action: ____________________
Please see page 4 for instructions. For more information about Power of Attorney Declaration or revoking prior declarations, see FTB 1144, Power
of Attorney: Frequently Asked Questions.
1. 1. 1. 1. 1. T T T T T AXP
AXP
AXP
AXPA A A A A YER INFORMA
AXP
YER INFORMA
YER INFORMA
YER INFORMA
YER INFORMATION
TION
TION
TION
TION
A) A) A) A) A) If this regards personal income tax, please provide:
If this regards personal income tax, please provide:
If this regards personal income tax, please provide:
If this regards personal income tax, please provide:
If this regards personal income tax, please provide:
Taxpayer’s Name
Taxpayer’s Social Security Number
—
—
Spouse’s Name, if Applicable
Spouse’s Social Security Number
—
—
Address
Home Telephone Number
(
)
—
City and State
Taxpayer’s Day Telephone Number
(
)
—
Zip Code/Country if Foreign
Spouse’s Day Telephone Number
(
)
—
B) B) B) B) B) If this regards Bank, Corporation, Partnership, or Limited Liability Company tax matters, please provide:
If this regards Bank, Corporation, Partnership, or Limited Liability Company tax matters, please provide:
If this regards Bank, Corporation, Partnership, or Limited Liability Company tax matters, please provide:
If this regards Bank, Corporation, Partnership, or Limited Liability Company tax matters, please provide:
If this regards Bank, Corporation, Partnership, or Limited Liability Company tax matters, please provide:
Business Name
Tax Identification Number (California Corporation, Federal Employer,
OR Secretary of State):
Address
Type of Business
Corporation
(Please check one)
Partnership
City and State
Limited Liability Company
ZIP Code/Country if Foreign
Telephone Number
(
)
—
(NOTE:
NOTE:
NOTE:
NOTE:
NOTE: You MUST
MUST
MUST
MUST
MUST complete and attach Schedule for Multiple Banks and Corporations (page 3), if this Power of Attorney Declaration applies to
combined reporting of more than one bank or corporation).
2. 2. 2. 2. 2. REPRESENT
REPRESENT
REPRESENT
REPRESENT
REPRESENTA A A A A TIVE(S)
TIVE(S)
TIVE(S)
TIVE(S)
TIVE(S)
As a party to the tax matter before the Franchise Tax Board or as owner, officer, receiver, administrator, or trustee for
the taxpayer, I hereby appoint the following person(s) to represent the taxpayer(s) for specified tax matters arising under
the Personal Income Tax Law, Bank and Corporation Tax Law, and/or the Administration of the Franchise and Income
Tax Laws for the tax year(s) or income year(s):
(SPECIFY T
(SPECIFY T
(SPECIFY T
(SPECIFY T
(SPECIFY TAX YEARS OR INCOME YEARS)
AX YEARS OR INCOME YEARS)
AX YEARS OR INCOME YEARS)
AX YEARS OR INCOME YEARS)
AX YEARS OR INCOME YEARS) _________________________________________________
(You must enter names of individuals. Do not enter names of accounting or law firms or other businesses.)
(You must enter names of individuals. Do not enter names of accounting or law firms or other businesses.)
(You must enter names of individuals. Do not enter names of accounting or law firms or other businesses.)
(You must enter names of individuals. Do not enter names of accounting or law firms or other businesses.)
(You must enter names of individuals. Do not enter names of accounting or law firms or other businesses.)
Representative’s Name
IRS Centralized Authorization File Number
Address
Telephone Number
(
)
—
City and State
Fax Number
(
)
—
Check if new
ZIP Code/Country if Foreign
Address
Telephone Number
Representative’s Name
IRS Centralized Authorization File Number
Address
Telephone Number
(
)
—
City and State
Fax Number
(
)
—
ZIP Code/Country if Foreign
Check if new
Address
Telephone Number
Representative’s Name
IRS Centralized Authorization File Number
Address
Telephone Number
(
)
—
City and State
Fax Number
(
)
—
ZIP Code/Country if Foreign
Check if new
Address
Telephone Number
(THE REVERSE SIDE OF THIS FORM MUST BE COMPLETED.)
(THE REVERSE SIDE OF THIS FORM MUST BE COMPLETED.)
(THE REVERSE SIDE OF THIS FORM MUST BE COMPLETED.)
(THE REVERSE SIDE OF THIS FORM MUST BE COMPLETED.)
(THE REVERSE SIDE OF THIS FORM MUST BE COMPLETED.)
FTB 3520 (REV 06-1999) PAGE 1
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