California Form 3555l - Request For Tax Clearance Certificate - 2004

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Request for Tax Clearance Certificate
CALIFORNIA FORM
Limited Liability Company or Limited Liability Partnership
3555L
Limited Liability Company (LLC) or Limited Liability Partnership (LLP) Name
Secretary of State File Number
Current Address
Phone Number
Federal Employer Identification Number
(
)
Date business commenced
Date business ceased
Latest California tax return
in California:
or will cease in California:
Income period:
Date filed:
Has the IRS changed the LLC’s or
All tax returns must be filed and balances due must be paid or
LLP’s income tax liability for any years
secured before we will issue a Tax Clearance Certificate. All returns
that you have not reported to us?
will remain subject to audit until the expiration of the normal statutes
Yes
No
of limitations.
If yes, send us a copy of the Revenue
If an individual or another business entity will act as the Assumer of any
Agent’s Report.
future tax liability, check the Assumer box below and follow the
appropriate instructions. Requests taking advantage of the Assumer
If the LLC or LLP is currently being
method generally receive a Tax Clearance Certificate within 30 days.
examined or an examination is
pending, identify the agency or
Assumer
Individual or Trust complete pages 2 and 3.
agencies below:
Corporate, LLC, or LLP complete pages 3 and 4.
IRS
FTB
Both
If you are requesting a tax clearance without an Assumer, check the
appropriate box below. Requests other than the Assumer method generally
If being examined, indicate which
take 6 to 9 months to receive a Tax Clearance Certificate.
years:
Current: ______________________
Surety Bond
Cash Deposit
Pending: _____________________
Taxes Paid – A final return must be filed before we will issue a
Tax Clearance Certificate based on Taxes Paid.
Check tax return form filed:
Form 100
Form 565
Form 568
Supplemental information. Please furnish the following information ONLY if another business entity will continue to
conduct the business in California after the current cancellation of the original LLC or LLP.
Name of Transferee
California Identification Number or Secretary of State File
Number of Transferee
Current Address
Phone Number
Federal employer identification number
(
)
Date Assets Transferred to Transferee
Section of the Internal Revenue Code applicable to the transfer of
taxpayer’s business or assets:
We will send a copy of the Tax Clearance Certificate to the California Secretary of State. If we are to mail the
original Tax Clearance Certificate to someone other than the LLC or LLP listed above, please complete the following:
Name
Phone Number
(
)
Address
Mail completed form to:
LIMITED LIABILITY COMPANY/PARTNERSHIP UNIT
SECRETARY OF STATE
PO BOX 944228
SACRAMENTO CA 94244-2280
For more information concerning this form, telephone the Franchise Tax Board at (916) 845-4124.
Assistance for persons with disabilities: We comply with the Americans with Disabilities Act. Persons with hearing or
speech impairments please call TTY/TDD (800) 822-6268.
FTB 3555L C1 (REV 10-2004) PAGE 1

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