Form Ftb 630 - Interpreter/translation Complaint Form

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STATE OF CALIFORNIA
EQUAL EMPLOYMENT OPPORTUNITY OFFICE MS A163
FRANCHISE TAX BOARD
PO BOX 550
SACRAMENTO CA 95812-0550
Interpreter/Translation Complaint Form
Complainant’s Name
Daytime Telephone
Address
City
State
Zip Code
Please supply the information requested below.
1. The date of the incident that prompted your complaint
2. Provide a detailed description of the actions or circumstances that prompted your complaint. Include the
Franchise Tax Board business area and names of any staff members involved in your complaint.
3. List any steps taken to resolve this issue. If you spoke to one of our staff members to resolve this issue before
you filed a complaint, provide their name and title, if available.
4. Describe the resolution you are seeking from us.
Submit completed form to:
EQUAL EMPLOYMENT OPPORTUNITY OFFICE MS A163
FRANCHISE TAX BOARD
PO BOX 550
SACRAMENTO CA 95812-0550
Upon receipt, we will process your complaint and a representative will contact you.
FTB 630 (REV 01-2012)

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