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California Power of Attorney Declaration for the Franchise Tax Board Form


California Power of Attorney Declaration for the Franchise Tax Board Form
California Power of Attorney Declaration for the Franchise Tax Board Form
This Power of Attorney Declaration will remain in effect until you fully resolve the matters specified in the
declaration or revoke it.
You can find instructions for this Power of Attorney Declaration on pages 3 and 4. For more information about power of
attorney declarations and authorizations, see our publication, Power of Attorney (form FTB 1144).
1. Taxpayer information – Please provide names and identification numbers:
Taxpayer’s Name and Address – Personal or Business
(If joint power of attorney, include spouse’s name and address)
Social Security #:
- -
Business Entity Identification #:
CA Corp #:
- -
SOS #:
Check if new
address
FEIN:
Spouse’s address if different
Daytime Telephone #:
( ) -
Note: You must attach the schedules for multiple corporations if this Power of Attorney Declaration applies to combined
reporting of more than one corporation. (See Authorization Schedule for Multiple Corporations on page 5)
2. The taxpayers named above hereby appoint the following representatives as attorneys-in-fact:
Name and Address Primary Representative
IRS CAF #:
PTIN:
Telephone #: ( ) -
Fax #: ( ) -
Check if new
Address Telephone #:
Name and Address
IRS CAF #:
PTIN:
Telephone # ( ) -
Fax #: ( ) -
Check if new
Address Telephone #:
Attach list of additional representatives if necessary.
Note: Only the Primary Representative listed above will receive copies of your Franchise Tax Board computer-
generated notices as they become available, unless you indicate otherwise in section 7. (See instructions, page 3)
3. Specific matters and tax years to be covered (See instructions, page 3)
The representatives listed can represent the taxpayers before the Franchise Tax Board for the following:
Tax Years (required):
Matters (optional):
4. Tax information authorization
Check this box if your declaration only authorizes your representative to receive confidential tax information but not
to act as your attorney-in-fact. (See instructions, page 4)
5. Acts authorized: You authorize your representatives as attorneys-in-fact, to:
Receive and inspect confidential tax information.
Perform any and all acts that you can perform with respect to programs administered by the Franchise Tax Board,
for example the authority to sign any agreements, consents, or other documents. (See instructions, page 4)
The authority does not include the power to receive refund checks, the power to substitute another representative, or
the power to sign certain returns unless you specify otherwise in section 6. (See instructions, page 4)
6. List any specific additions or deletions to the acts otherwise authorized in this Power of Attorney Declaration.
STATE OF CALIFORNIA
FRANCHISE TAX BOARD
PO BOX 2828
RANCHO CORDOVA CA 95741-2828
FAX NUMBER: (916) 845-0523
POWER OF ATTORNEY
DECLARATION FOR THE FRANCHISE TAX BOARD
FTB 3520 C1 (REV 10-2002) PAGE 1
California Power of Attorney Declaration for the Franchise Tax Board Form
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