California Form 3555 - Request For Tax Clearance Certificate - Corporations

CORPORATION, LIMITED LIABILITY COMPANY, OR LIMITED LIABILITY

PARTNERSHIP ASSUMPTION OF TAX LIABILITY

The Assumption of Tax Liability

of (1) __________________________________________________________ )

)

A corporation

______________________________________________________________ ) ________________________

California Corporation number, Secretary of

)

State file number, or federal employer

identification number

by (2) _________________________________________________________ )

)

A corporation, limited liability company, or limited liability partnership

______________________________________________________________ ) ________________________

California Corporation number, Secretary of

State file number, or federal employer

identification number

(Name of assumer) __________________________________________________ unconditionally

agrees to file with the Franchise Tax Board all tax returns and data required and pay in full all tax

liabilities, penalties, interest and fees of (1) _________________________________________

_________________________________________________________________________________; at the

effective date of dissolution or surrender of the corporation.

(2) _________________________________________

Exact corporation, limited liability company, or limited liability partnership name

_______________________________________

_________________________________________

Printed name and title of officer/manager/partner/member

Signature and title of officer/manager/partner/member

State of _______________________________

County of _____________________________

On ________________________________________ before me, the undersigned, a notary public in and for

said state, personally appeared _______________________________________________________________

_______________________________________________________________________________________

personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s)

whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they

executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the

instrument the entity upon behalf of which the person(s) acted, executed the instrument.

WITNESS my hand and official seal.

Signature ________________________________________________________

Name __________________________________________________________

(typed or printed)

Note: LLC, LLP, and corporation assumers must provide a financial statement.

FTB 3555 C1 (REV 11-2003) PAGE 4

California Form 3555 - Request For Tax Clearance Certificate - Corporations - 2003 Page 4