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Form Ftb 3552 Pc C1 - Identity Theft Affidavit - State Of California Identity Theft Team Page 2

Submit the copies required above with this form using one of the options described on PAGE 2 of this form.

By Mail:

By Fax:

If you received a notice from FTB, return this

If you received a notice in the mail from FTB and a fax

form with a copy of the notice to the address con-

number is shown, fax this completed form with a copy of

tained in the notice.

the notice to that number. Include a cover sheet marked

“Confidential.” If no fax number is shown, follow the mailing

If you have not received an FTB notice and are

instructions.

self-reporting potential risk for future impact to

your tax account, mail this form to:

FTB does not initiate contact with taxpayers by email or fax.

IDENTITY THEFT TEAM MS A462

If you have not received an FTB notice and are self-reporting

FRANCHISE TAX BOARD

potential risk for future impact to your tax account, fax this form

PO BOX 2952

to:

SACRAMENTO CA 95812-2952

916.843.0561

Go to privacyprotection.ca.gov and search for identity theft for additional resources and information regarding identity

theft.

Get FTB 1131, Franchise Tax Board Privacy Notice, at ftb.ca.gov or call 800.338.0505. If outside the United States, call

916.845.6500.

Internet and Telephone Assistance

Website:

ftb.ca.gov

Telephone: 800.852.5711 from within the United States

916.845.6500 from outside the United States

TTY/TDD:

800.822.6268 for persons with hearing or speech impairments

PAGE 2

FTB 3552 PC C1 (NEW 06-2012)

Form Ftb 3552 Pc C1 - Identity Theft Affidavit - State Of California Identity Theft Team Page 2