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Form 8453-Be (Pmt) - California Payment For Automatic Extension Authorization For Business Entities - 2016

DO NOT MAIL THIS FORM TO THE FTB

Date Accepted

California Payment for Automatic

TAXABLE YEAR

FORM

2016

8453-BE (PMT)

Extension Authorization for Business Entities

Name of business entity (corporation, limited liability company, or partnership)

Identifying number

Part I

Extension Payment Information for Taxable Year 2016

1 Electronic Funds Withdrawal (EFW) Amount

2 Withdrawal Date (mm/dd/yyyy)

Part II

Banking Information for Electronic Funds Withdrawal

3 Routing number

4 Account number

5 Type of account:  Checking

 Savings

Payment Authorization

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.

Signature of

Date

business entity's

Sign



representative

Here



Title

Paid Preparer

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.

PTIN

Paid preparer’s

Sign



signature

Here

Date



Firm’s name

KEEP THIS FORM FOR YOUR RECORDS – DO NOT MAIL TO THE FRANCHISE TAX BOARD (FTB)

FTB 8453-BE (PMT)

2016)

(NEW

For Privacy Notice, get FTB 1131 ENG/SP.

Form 8453-Be (Pmt) - California Payment For Automatic Extension Authorization For Business Entities - 2016

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