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California Franchise Tax Board Power of Attorney Declaration Form

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California Franchise Tax Board Power of Attorney Declaration Form
California Franchise Tax Board Power of Attorney Declaration Form
FTB 3520 (REV 09-2013) C1 PAGE 1
FRANCHISE TAX BOARD
Power of Attorney Declaration
Part 1 – Taxpayer Information
Individual (Do not complete Fiduciary or Business Entity section of Part 1)
Taxpayer Name: Initial: Last Name: SSN or ITIN:
Address (suite, room, PO Box, or PMB no.): Check if new address . Telephone No.:
( ) -
City: State: ZIP Code:
Fiduciary (estates and trusts)
Estate or Trust Name: SSN or ITIN: FEIN:
Address (suite, room, PO Box, or PMB no.): Check if new address . Telephone No.:
( ) -
Fax No.:
( ) -
City: State: ZIP Code:
Business Entity
Business Name (Corporations filing a combined return, see instructions.): CA Corp No.:
Address (suite, room, PO Box, or PMB no.): Check if new address . FEIN: CA SOS No.:
City: State: ZIP Code: Telephone No.:
( ) -
Fax No.:
( ) -
Part 2 – Representative
The taxpayer in Part 1 appoints the following representative(s) as attorney(s)-in-fact:
Primary Representative
Check if new Address Telephone no.
To appoint additional representatives attach a list including all required information to this form.
Name: IRS CAF No.: PTIN:
Address (suite, room, PO Box, or PMB no.): Telephone No.:
( ) -
Fax No.:
( ) -
City: State: ZIP Code:
Email address:
Additional Representative Check if new Address Telephone no.
Name: IRS CAF No.: PTIN:
Address (suite, room, PO Box, or PMB no.): Telephone No.:
( ) -
Fax No.:
( ) -
City: State: ZIP Code:
Part 3 – Authorization for All Tax Years or Income Periods for a Limited Duration
I authorize the listed representative(s), in addition to anything otherwise authorized on this form, to represent me regarding any
matters with the Franchise Tax Board regardless of tax years or income periods. I understand that this authority will expire four
years from the date this POA is signed or a new POA is filed revoking this authorization.
352000091371
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California Franchise Tax Board Power of Attorney Declaration Form
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