Form Ftb 3520 C1 - Ranchise Tax Board Power Of Attorney Declaration
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FRANCHISE TAX BOARD
Power of Attorney Declaration
See General Instructions to complete this form.
Part 1 – Taxpayer Information
Complete appropriate section, sign, and date on PAGE 2.
Individual (Do not complete Fiduciary or Business Entity section of Part 1)
Taxpayer name
Initial Last name
SSN or ITIN
Address (suite, room, PO Box, or PMB no.) Check if new address .
Telephone no.
(
)
-
City
State
ZIP code
Fiduciary (estates and trusts)
Estate or trust name
SSN or ITIN
FEIN
Address (suite, room, PO Box, or PMB no.) Check if new address .
Telephone no.
Fax no.
(
)
-
(
)
-
City
State
ZIP code
Business Entity
Business name (Corporations filing a combined return, see instructions.)
CA Corp no.
Address (suite, room, PO Box, or PMB no.) Check if new address .
FEIN
CA SOS no.
City
State
ZIP code
Telephone no.
Fax no.
(
)
-
(
)
-
Part 2 – Representative
The taxpayer in Part 1 appoints the following representative(s) as attorney(s)-in-fact:
(Check if new Address Telephone no.)
Primary Representative
To appoint additional representatives attach a list including all required information to this form.
Name
IRS CAF no.
PTIN
Address (suite, room, PO Box, or PMB no.)
Telephone no.
Fax no.
(
)
-
(
)
-
City
State
ZIP code
Email address
(Check if new Address Telephone no.)
Additional Representative
Name
IRS CAF no.
PTIN
Address (suite, room, PO Box, or PMB no.)
Telephone no.
Fax no.
(
)
-
(
)
-
City
State
ZIP code
Part 3 – General Privileges
You authorize your representative as attorney-in-fact to perform any action you might perform to resolve your issues with us such as:
• Talk to Franchise Tax Board (FTB) agents about your account.
• Waive the California statute of limitations.
• Receive and inspect your confidential tax information.
• Execute settlement and closing agreements.
• Represent you in FTB matters.
• Request information we receive from IRS.
Part 4 – Authorization for All Tax Years or Income Periods for a Limited Duration
I authorize the listed representative(s), in addition to anything otherwise authorized on this form, to represent me regarding any
matters with the Franchise Tax Board regardless of tax years or income periods. I understand that this authority will expire four
years from the date this POA is signed or a new POA is filed revoking this authorization.
FTB 3520 c1 (REV 12-2012) PAGE 1
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