Form 6274a C3 - Extension Request To File Information Returns Electronically
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STATE OF CALIFORNIA
DATA EXCHANGE MS L120
FRANCHISE TAX BOARD
PO BOX 1468
SACRAMENTO CA 95812-1468
916.845.3778
Extension Request to File Information Returns Electronically
Firm Name:
Date:
/
/
Mailing Address:
Federal Employer Identification Number:
–
City/State/ZIP Code:
Waiver Request for
Tax Year:
Contact Name:
Title:
Telephone Number:
.
.
.
I request a ______ day extension past the filing deadline to file information returns.
Note: Request must not exceed 90 days.
Request involves return types:
1098
1099
5498
W-2G
Briefly explain your need for an extension:
The approval of this extension is only for the filing of information returns to the Franchise Tax Board. The
payer/employer is still required to provide payees/employees with their paper return copies postmarked by the prescribed
due dates of May 31 for Form 5498 and January 31 for all other information returns. If the corresponding due date falls on
a Saturday, Sunday, or legal holiday, the due date is extended to the next business day.
I declare that I have examined this form, including any accompanying statements, and, to the best of my knowledge
and belief, it is true, correct, and complete.
Signature:
Title:
Date:
/
/
Note: This completed form can be faxed to:
Data Exchange Services
916.845.5550
FTB 6274A C3 (REV 10-2009)
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