DO NOT MAIL THIS FORM TO THE FTB
California Payment for Automatic Extension
and Estimate Payment Authorization for Individuals
Your SSN or ITIN
Spouse’s/RDP’s SSN or ITIN
Extension Payment Information for Taxable Year 2016 (Payment due 4/18/2017)
1 Electronic Funds Withdrawal (EFW) Amount
2 Withdrawal Date (mm/dd/yyyy)
Scheduled Estimated Tax Payments for Taxable Year 2017 These are NOT installments of the current amount you owe.
First Payment Due 4/18/2017 Second Payment Due 6/15/2017
Third Payment Due 9/15/2017
Fourth Payment Due 1/16/2018
4 Withdrawal Date
Part III Banking Information for Electronic Funds Withdrawals from Parts I and II
5 Routing number
6 Account number
7 Type of account: Checking
I authorize an EFW on the date indicated on line 2 for the amount stated on line 1, plus EFWs for the estimated payments to be made
on the dates indicated on line 4, for each amount stated on line 3, corresponding to the estimated payment date. The above EFWs
are to be made from the bank indicated on lines 5, 6, and 7. This authorization will remain in effect unless I contact the FTB to cancel
the request. I request that the payment(s) 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, it is 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 (PMT) (NEW 2016)
For Privacy Notice, get FTB 1131 ENG/SP.