California Form 3555 - Request For Tax Clearance Certificate - Corporations

California Form 3555 - Request For Tax Clearance Certificate - Corporations - 2003 Page 2

Please complete Section A or B below.

A. INDIVIDUAL ASSUMPTION OF TAX LIABILITY

Corporation name

California corporation number

Current address

Phone number

Federal employer identification number

(

)

I unconditionally agree to file or cause to be filed with the Franchise Tax Board, under the provisions of the Bank and

Corporation Tax Law, all tax returns and data required and to pay in full all accrued or accruing tax liabilities, penalties,

interest, and fees due from the above named corporation at the effective date of dissolution or surrender.

My net worth (assets minus liabilities) is not less than: $ _____________________ .

(We require a detailed financial statement [PAGE 3].)

Name of individual assumer (print)

Social security number

Address

Phone number (

)

Date

Signature

B. TRUST ASSUMPTION OF TAX LIABILITY

Corporation name

California corporation number

Current address

Phone number

Federal employer identification number

(

)

This trust unconditionally agrees to file or cause to be filed with the Franchise Tax Board, under the provisions of the

Bank and Corporation Tax Law, all tax returns and data required and to pay in full all accrued or accruing tax liabilities,

penalties, interest, and fees due from the above named corporation at the effective date of dissolution or surrender:

(We require a detailed financial statement [PAGE 3].)

Name of trust

Trust federal identification number

Address

Phone number (

)

Date

Trustee’s name (print)

Trustee’s signature

FOR PRIVACY ACT NOTICE, GET FORM FTB 1131.

FTB 3555 C1 (REV 11-2003) PAGE 2

California Form 3555 - Request For Tax Clearance Certificate - Corporations - 2003 Page 2