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Form Ftb 3570 - Waiver Extending Statute Of Limitations For Proposing Deficiency Assessments

STATE OF CALIFORNIA

FRANCHISE TAX BOARD

PO BOX 2487

SACRAMENTO

CA 93303-2487

TELEPHONE:

(916)

WAIVER EXTENDING STATUTE OF LIMITATIONS

FOR PROPOSING DEFICIENCY ASSESSMENTS

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Taxpayer(s)

Corporate Number

Return(s) for income years ended

Statute of limitations extended to

The taxpayer(s) named above consent(s) and agree(s) that the amount of any deficiency in taxes or penalties,

including interest, due under any return(s) made by or on behalf of the taxpayer(s) for the year(s) indicated may

be proposed to be assessed at any time on or before the extended date shown above.

The signing and acceptance of this consent will automatically result in an extension of the period within which a

claim for refund may be filed if such period has not expired prior to the filing of this consent.

Date

TAXPAYER

Date

TAXPAYER

SIGNATURE OF OFFICER

TITLE

NOTE: A corporate waiver must be signed by a principal officer or duly authorized agent. An individual's

signature above shall be prima-facie evidence that such individual is authorized to sign this waiver on

behalf of the corporation.

Waivers signed by a representative or an attorney-in-fact must be accompanied by a completed power of

attorney authorizing such signature.

You are not required to agree to this extension of time for assessment. You may refuse to grant any

extension or you may agree to an extension for a limited period of time:. If you choose either of these

options, we may issue a proposed assessment based on information available to us. If you choose to

change the extension date, please contact us for a revised statute waiver form.

FTB 3570 (REV 12-2000)

Form Ftb 3570 - Waiver Extending Statute Of Limitations For Proposing Deficiency Assessments