Form Ftb 3557 Bc - Application For Certificate Of Revivor - 2009

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STATE OF CALIFORNIA
FRANCHISE TAX BOARD
PO BOX 942857
SACRAMENTO CA 94257-2021
Notice Date:
APPLICATION FOR CERTIFICATE OF REVIVOR
Before the California Franchise Tax Board
In the Matter of the Application for Certificate of Revivor of:
Entity Number
:
FEIN Number
:
SOS Number
:
Entity Name
:
Address
:
I request relief from suspension or forfeiture for this entity. I previously submitted or I am enclosing all required
payments, returns, or documents.
Print Name _____________________________________
Title ________________________________
Signature ______________________________________
Date ________________________________
Daytime Phone Number ___________________________
Those who can sign this application on behalf of an entity (domestic or foreign) include:
• Any stockholder, creditor, member, general partner, or officer.
• Any person having an interest in relief from suspension or forfeiture.
Domestic entities can also have a majority of the surviving trustees or directors sign on their behalf.
FTB 3557 BC (REV 11-2009)

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