Form Ftb 3571 C2 - Request For Estate Income Tax Clearance Certificate
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Request for Estate
STATE OF CALIFORNIA
FRANCHISE TAX BOARD
Income Tax Clearance Certificate
Telephone: 916.845.4210
Fax: 916.843.0422
Expedite Request
Please read side 2 before completing this form.
($100 nonrefundable fee – Read side 2)
Complete and send your request to us at least
30 days before the court hearing on the final
MAIL TO:
ESTATE INCOME TAX CLEARANCE CERTIFICATE UNIT MS F320
account.
FRanChIsE Tax BoaRd
Allow at least 30 days for a response.
PO BOX 1673
SACRAMENTO CA 95812-1673
Approximate date of court hearing: ____________
Estate of
Federal Employer ID. No.
Date of Death
Name of Fiduciary
Area Code and Phone No.
Decedent’s Social Security No.
.
.
Address of Fiduciary (Number and Street)
Probate No.
City or Town, State, and ZIP Code
County of Probate
Name of Attorney
Area Code and Phone No.
.
.
Address of Attorney (Number and Street)
Mail Tax Clearance Certificate to:
Attorney
City or Town, State, and ZIP Code
Fiduciary
answer “yes” or “no” to these questions and furnish the required documents.
1. Did the decedent reside in the State of California on the date of death? __________
2. Did probate begin in any other state? __________
3. Did fair market value of the estate’s assets on the date of death exceed $1 million? __________ (If no, you do not need an Estate
Income Tax Clearance Certificate. See Certificate Filing Requirements on side 2. ) (If yes, attach a copy of IRS Form 706, if required
for federal.)
4. Will probate assets exceeding $250,000 be distributed to nonresident beneficiaries? __________ (If no, you do not need an Estate
Income Tax Clearance Certificate. See Certificate Filing Requirements on side 2.)
5. Did preliminary distribution begin? __________ (If yes, furnish a copy of the court order authorizing the distribution.)
declaration – California Returns Filed for decedent and Estate
Complete this section and include the four taxable years preceding the date of this request.
decedent
California Individual Income Tax Returns (Form 540, 540A, 540 2EZ, or 540NR - Long or Short Form) filed by or on behalf of the
decedent for the following years: ________, ________, ________, and ________.
Explain in full if the returns for any of the above years were not filed: ____________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Estate
California Fiduciary Income Tax Return (Form 541) filed for the following years: ________, ________, ________, and ________.
Explain in full if fiduciary returns were not filed for any of the last four years the estate existed: ________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
I declare, under penalties of perjury, the information above is true to the best of my knowledge and belief.
_______________________________________________________
__________________________________________
___________________________
Signature of fiduciary or representative
Title
Date
FTB 3571 C2 (REV 02-2011) SIDE 1
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