Form Ftb 3520 C1 - Ranchise Tax Board Power Of Attorney Declaration Page 3

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Authorizing Schedule for Corporations Filing a Combined Report
You must complete this schedule if this POA applies to the combined reporting. Provide information for each corporation that this POA is
executed on behalf of. List the individual who signs the POA as a common corporate officer, receiver, administrator, or trustee for each
of the taxpayer(s) listed below. Attach additional authorization schedules if necessary. More information, see General Instructions.
Corporation name
CA Corp no.
Address (suite, room, PO Box, or PMB no.)
FEIN
CA SOS no.
City
State
ZIP code
Telephone no.
Fax no.
(
)
-
(
)
-
Title – Required
Corporation’s authorized individual – Required
Corporation name
CA Corp no.
Address (suite, room, PO Box, or PMB no.)
FEIN
CA SOS no.
City
State
ZIP code
Telephone no.
Fax no.
(
)
-
(
)
-
Title – Required
Corporation’s authorized individual – Required
Corporation name
CA Corp no.
Address (suite, room, PO Box, or PMB no.)
FEIN
CA SOS no.
City
State
ZIP code
Telephone no.
Fax no.
(
)
-
(
)
-
Title – Required
Corporation’s authorized individual – Required
Corporation name
CA Corp no.
Address (suite, room, PO Box, or PMB no.)
FEIN
CA SOS no.
City
State
ZIP code
Telephone no.
Fax no.
(
)
-
(
)
-
Title – Required
Corporation’s authorized individual – Required
FTB 3520 c1 (REV 12-2012) PAGE 3

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