California Form 3555a - Request For Tax Clearance Certificate Form
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CALIFORNIA FORM
Request for Tax Clearance
3555A
Certifi cate — Exempt Organizations
Corporation Name
California Identifi cation Number
Current Address
Phone Number
Federal Employer Identifi cation Number
(
)
Date operations commenced
Date operations ceased or will
Latest tax year for which a
Date fi led:
in California:
cease in California:
California return was fi led:
Requestor Name ________________________________ Requestor Signature ________________________________
We will issue a Tax Clearance Certifi cate when all taxes are paid or secured. If you have not yet fi led a fi nal
return, you must fi le one.
Notes
1. All public benefi t corporations, all religious corporations, and those mutual benefi t corporations holding charitable
assets in trust must also obtain a Dissolution Waiver of Notice from the California Attorney General in order to com-
plete dissolution. For guidance in requesting the waiver, refer to the Attorney General’s publication General Guide for
Dissolving a California Nonprofi t Corporation (CT-603). You may view and download the publication on the Attorney
General’s Website at
2. Until the applicable statutes of limitation expire, we may audit your returns and impose additional tax, if warranted,
even though we issued a Tax Clearance Certifi cate.
Please indicate the status of any IRS activity:
Is the IRS or the FTB currently examining the corpora-
Has the IRS changed the corporation’s income tax liability
tion or has either notifi ed the corporation of a pending
or issued a ruling as to federal income tax exemption for
examination?
any years that you have not reported to us?
Yes
No If yes, indicate the years involved:
Yes
No
Current Examination:
_____________________
If yes, send us a copy of the Revenue Agent’s Report.
Pending Examination:
_____________________
If we are to mail the Tax Clearance Certifi cate or any correspondence to someone other than the corporation listed above,
please complete the following: (We will send a copy of the Tax Clearance Certifi cate to the Secretary of State.)
Name
Address
Phone Number (
)
Mail completed form to:
DOCUMENT FILING SUPPORT UNIT
SECRETARY OF STATE – BUSINESS FILINGS
1500 11TH STREET
SACRAMENTO CA 95814-5701
For more information concerning this form, telephone the Franchise Tax Board at (916) 845-4171.
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 3555A C1 (REV 05-2006)
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