Form Ftb 3571 C2 - Request For Estate Income Tax Clearance Certificate

REQUEST FOR ESTATE

STATE OF CALIFORNIA

FRANCHISE TAX BOARD

INCOME TAX CLEARANCE CERTIFICATE

Telephone (916) 845-4210

As required under California Revenue

Fax (916) 845-3135

and Taxation Code Section 19513

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Expedite Request (see instructions)

PLEASE READ INSTRUCTIONS ON SIDE 2 BEFORE COMPLETING THIS FORM

MAIL TO: ESTATE INCOME TAX CLEARANCE UNIT, MS F150

FRANCHISE TAX BOARD

FILE AT LEAST 30 DAYS PRIOR TO THE COURT

PO BOX 1468

HEARING ON FINAL ACCOUNT. APPROXIMATE

SACRAMENTO CA 95812-1468

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:

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Attorney

City or Town, State, and ZIP Code

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Fiduciary

ANSWER THESE QUESTIONS AND FURNISH THE REQUIRED DOCUMENTS

1. Was decedent a resident of the State of California on the date of death? ______________

(If “no,” furnish a copy of the California Estate Tax Return (Form ET-1) and Declaration Concerning Residence (Form IT-2) if filed

with the California State Controller).

2. Have probate proceedings been instituted in any other state? _____________

3. Value of the assets of this estate on date of death. (Please attach federal Form 706.) __________________________

(If not exceeding $1,000,000, you do not need an Estate Income Tax Clearance Certificate. See instructions on Side 2.)

4. Are assets exceeding $250,000 distributable to one or more nonresident beneficiaries? ________________

(If “no,” you do not need an Estate Income Tax Clearance Certificate. See instructions on Side 2.)

Has a preliminary distribution been made? _______________

(If “yes,” furnish a copy of the court order authorizing the distribution.)

You must file a return for all taxable years that have ended (even if a return is not yet due), or submit a deposit in

the form of check or bond in an amount to be determined by this office. We require a Specialized Tax Service Fee

for Expedited Estate Income Tax Clearance Certificate Requests. See instructions on Side 2.

DECLARATION REGARDING CALIFORNIA RETURNS FOR DECEDENT AND FOR ESTATE

(To be completed for the four taxable years immediately preceding the date of this request.)

A. DECEDENT

California Individual Income Tax Returns (Form 540, 540A, 540 2EZ, or Long or Short Form 540NR) have been filed

by or on behalf of the decedent for the following years: ________ ________ ________ ________ . If the returns

were not filed for any of the above years, explain in full: _________________________________________________

_____________________________________________________________________________________________

B. ESTATE

California Fiduciary Income Tax Returns (Form 541) have been filed for the following years:

________ ________ ________ ________ . If fiduciary returns were not filed for any of the last four years during

which the estate was in existence, explain in full: ______________________________________________________

_____________________________________________________________________________________________

I declare, under penalties of perjury, that the information given above is true to the best of my knowledge and belief.

_________________________________________ __________________________________ __________________

SIGNATURE OF FIDUCIARY OR REPRESENTATIVE

TITLE

DATE

ALLOW AT LEAST 30 DAYS FOR A RESPONSE TO THIS APPLICATION

FTB 3571 C2 (REV 10-2007) SIDE 1

Form Ftb 3571 C2 - Request For Estate Income Tax Clearance Certificate - 2007

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