Form Ftb 4800 Meo C1 - Federally Tax-Exempt Non-California Bond Interest And Interest-Dividend Payment Information Media Transmittal

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STATE OF CALIFORNIA
BOND INTEREST MS F310
FRANCHISE TAX BOARD
PO BOX 1998
RANCHO CORDOVA CA 95741-1998
Interest and Interest-Dividend Payment Reporting Requirement Letter
The law requires you to report payments of interest or interest-dividends on federally tax-exempt non-
California municipal bonds during 2012 to the California Franchise Tax Board (FTB). (Revenue and
Taxation Code (R&TC) Section 18639)
The filing requirement applies whether a bond is held directly by an individual or partnership through
a mutual fund, a money market fund, a unit investment trust, or other financial investment vehicle.
You must report payments of interest income on a per bond basis, as well as payments of interest
dividends on a per shareholder basis to the FTB by June 1, 2013.
The law requires you to inform payees by January 31, 2013, that you are reporting this information to
the FTB.
You must report payments if the payments meet both of the following conditions:
Aggregate payments are $10 or more.
●
Payments are made to individuals or partnerships with a California address.
●
Complete the information below. Check the box that applies, sign and date the bottom of this page,
and return your response in the enclosed envelope to:
BOND INTEREST MS F310
FRANCHISE TAX BOARD
PO BOX 1998
RANCHO CORDOVA CA 95741-1998
I have a filing requirement. I am providing the requested information through a clearing firm listed below:
Name of Clearing Firm:
Address:
Telephone: (
)
-
I have a filing requirement. I submitted the requested information through electronic media transmittal.
I do not have a filing requirement. Please explain:
Other. Please explain:
I declare under penalty of prejury that the above statements are true and correct to the best of my knowledge
and belief.
Print Name
Signature
Date
FTB 4800 MEO C1 (REV 10-2012) PAGE 1

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