DO NOT MAIL THIS FORM TO THE FTB
California Payment for Automatic
Extension Authorization for Business Entities
Name of business entity (corporation, limited liability company, or partnership)
Extension Payment Information for Taxable Year 2016
1 Electronic Funds Withdrawal (EFW) Amount
2 Withdrawal Date (mm/dd/yyyy)
Banking Information for Electronic Funds Withdrawal
3 Routing number
4 Account number
5 Type of account: Checking
I authorize an EFW on the date indicated on line 2 for the amount stated on line 1. The above EFW is to be made from the bank
indicated on lines 3, 4, and 5. This authorization will remain in effect unless I contact the FTB to cancel the request. I request that the
payment above be deducted from the bank account on the date specified above. If this date falls on a Saturday, Sunday, or holiday, the
transfer is authorized for the next business day. If the FTB cannot deduct the payment from the account because of insufficient funds
or because the bank account is closed, the FTB may charge a dishonored payment penalty. I will be responsible for any overdraft fees
charged by the bank. Under penalties of perjury under the laws of the State of California, I declare that I have completed this payment
authorization to the best of my knowledge and belief; it is true, correct, and complete.
Under penalties of perjury, I declare that I have examined the above taxpayer’s payment information, and to the best of my knowledge
and belief, they are true, correct, and complete. I make this declaration based on all information of which I have knowledge.
KEEP THIS FORM FOR YOUR RECORDS – DO NOT MAIL TO THE FRANCHISE TAX BOARD (FTB)
FTB 8453-BE (PMT)
For Privacy Notice, get FTB 1131 ENG/SP.