Form 8633 California Application To Participate In The E-File Program (Page 2 of 2) in pdf

Has the firm or any corporate officer, partner, owner, or responsible official:

Been assessed any California preparer penalties?

Yes

Been convicted of a crime?

Yes

Failed to file California personal or business tax returns, or pay liabilities?

Yes

Been convicted of any criminal offense under the U.S. Internal Revenue or

California Revenue and Taxation Codes?

Yes

If the answer is yes to any of the above inquiries, attach a written explanation describing all pertinent facts.

Firm’s Organization Structure

If you are NOT a government agency, VITA/TCE site, or providing electronic filing free of charge, you MUST complete this section

as specified in the instructions on Side 4. If additional space is required, attach a separate sheet.

Name

Title

Home Address

Social Security Number

Responsible Official/Application Agreement

The responsible official is the individual with responsibility for and authority over the operations at designated sites.

The responsible official is the first point of contact with the Franchise Tax Board, who has the authority to sign revised

applications, and is responsible for ensuring that all requirements of our e-file program are adhered to. The

responsible official may be responsible for more than one office.

Under penalties of perjury, I declare that I have examined this application and any accompanying information, and to

the best of my knowledge and belief it is true, correct, and complete. This firm and its employees will comply with all

the provisions of FTB Pub. 1345, e-file Handbook for Authorized e-file Providers of California Individual Income Tax

Returns, and related publications, including fraud prevention and detection guidelines for each year of participation. I

understand that if this firm is sold or its organizational structure is changed, acceptance for participation is not

transferable and a new application must be filed. I agree to retain form FTB 8453, California Individual Income Tax

Declaration for e-file , signed by the taxpayer in the form prescribed by the Franchise Tax Board. I further understand

that noncompliance will result in the firm or individual no longer being allowed to participate in the program. I am

authorized to make and sign this statement on behalf of the firm.

Name and title of the firm’s official and/or principal owner (type or print)

Signature of the firm’s official and/or principal owner

Date

Side 2 FTB 8633

2001

(REV. 11-2001)

Form 8633 California Application To Participate In The E-File Program Page 2