Form 911 - Request For Relief From Hardship
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1STATE OF CALIFORNIA
911
COLLECTION FORM
FRANCHISE TAX BOARD
PO BOX 2952
REQUEST FOR RELIEF FROM HARDSHIP
SACRAMENTO CA 95812-2952
(For Tax Practitioner Use Only)
NOTE: This form should be accompanied by a completed Power of Attorney (FTB Form 3520)
Taxpayer name
Taxpayer SSN
Practitioner name
Telephone number
(
)
Spouse name
Spouse SSN
Fax number
(
)
Taxpayer address
Practitioner Address
(Street, City, State and ZIP)
(Street, City, State and ZIP)
Please describe the hardship. Attach additional pages as needed.
Describe the relief requested. Attach additional pages as needed.
Please fax this form to (916) 845-0494, attention Tax Practitioner Collection Fax Line, or mail this
form to: FRANCHISE TAX BOARD, PO BOX 2952, SACRAMENTO CA 95812-2952
FTB Form 911 (New 03-1999)
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Parent category: Financial