FTB LIMITED LIABILITY CORPORATION TAX REFUND CASES

Judicial Council Coordination Proceeding No. 4742

City & County of SF Superior Court Case No. CGC-07-462728

Fresno County Superior Court Case No. 10CECG00434

If you received a personalized notice in the mail or via email with a Notice ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID exactly as it appears on your personalized Notice, (i.e. 12345678).

OR

If you did not receive a personalized Notice in the mail, or if you would like to file for an LLC or Tax Year(s) not included on the Claim Form mailed to you, click below to complete a Claim Form. You can also submit a claim form by mail.

Please note that this claims portal is scheduled to close on Pacific Time.

INSTRUCTIONS

You can use this form to file a claim for one year or more than one year. If your claim covers more than one year, you need to fill out one separate copy of STEP 2 for each year. Fill out ALL questions related to the Tax Year selected in STEP 2, then select another Tax Year from the drop down and fill out ALL questions again. For example, if your claim covers three years, you should answer the questions in STEP 2 three times, one for each year of your claim. You only need to fill out the other parts of this form once.

Your claim will be denied unless PART 3 is signed UNDER PENALTY OF PERJURY.

You MUST use your best efforts to answer the following questions truthfully and completely.
DO NOT PROVIDE INACCURATE INFORMATION.

THE CALIFORNIA FRANCHISE TAX BOARD MAY REVIEW THE INFORMATION THAT YOU PROVIDE AND MAY REFER ANY CLAIM FORMS THAT IT BELIEVES WERE SUBMITTED WITH FALSE OR FRAUDULENT INFORMATION TO APPROPRIATE LAW ENFORCEMENT AGENCIES FOR INVESTIGATION AND/OR PROSECUTION.

STEP 1: REVIEW YOUR LLC & CONTACT INFORMATION

You must submit proof of the LLC’s timely amended return or claim for refund for the tax year selected in STEP 2 AND proof that the LLC paid the LLC Fee for that year. Note: You can only submit claims for tax years 1994-2006.

1. If the below pre-populated information about your LLC is different, please provide updated information here:

2. Please provide the following information:

3. Please identify the designated contact person for the LLC listed above and preferred method of contact:

* Required Fields
STEP 2: PROVIDE YOUR LLC INCOME INFORMATION

You must provide information for only one tax year at a time in this section. If you are submitting claims for more than one year, answer all questions in STEP 2 in relation to the Tax Year selected and return to the drop down to select an additional year. Repeat as necessary for all applicable years before you click on the Submit button at the bottom of the page.

Please use the dropdown to switch between your Tax Years at issue.
The information below is for Tax Year:

4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


Please complete one of the options below.

OR


(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

This MUST be an exact figure based on your review of documents submitted with this Claim Form.

iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

Please check at least one box.

Or indicate:

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

File List: No Files Selected

    If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

    The above information is for Tax Year 1994. Please click here to switch to another available Tax Year.

    **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

    4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

    i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

    iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

    If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


    Please complete one of the options below.

    OR


    (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

    This MUST be an exact figure based on your review of documents submitted with this Claim Form.

    iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

    Please check at least one box.

    Or indicate:

    Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

    File List: No Files Selected

      If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

      The above information is for Tax Year 1995. Please click here to switch to another available Tax Year.

      **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

      4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

      i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

      iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

      If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


      Please complete one of the options below.

      OR


      (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

      This MUST be an exact figure based on your review of documents submitted with this Claim Form.

      iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

      Please check at least one box.

      Or indicate:

      Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

      File List: No Files Selected

        If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

        The above information is for Tax Year 1996. Please click here to switch to another available Tax Year.

        **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

        4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

        i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

        iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

        If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


        Please complete one of the options below.

        OR


        (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

        This MUST be an exact figure based on your review of documents submitted with this Claim Form.

        iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

        Please check at least one box.

        Or indicate:

        Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

        File List: No Files Selected

          If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

          The above information is for Tax Year 1997. Please click here to switch to another available Tax Year.

          **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

          4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

          i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

          iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

          If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


          Please complete one of the options below.

          OR


          (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

          This MUST be an exact figure based on your review of documents submitted with this Claim Form.

          iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

          Please check at least one box.

          Or indicate:

          Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

          File List: No Files Selected

            If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

            The above information is for Tax Year 1998. Please click here to switch to another available Tax Year.

            **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

            4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

            i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

            iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

            If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


            Please complete one of the options below.

            OR


            (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

            This MUST be an exact figure based on your review of documents submitted with this Claim Form.

            iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

            Please check at least one box.

            Or indicate:

            Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

            File List: No Files Selected

              If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

              The above information is for Tax Year 1999. Please click here to switch to another available Tax Year.

              **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

              4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

              i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

              iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

              If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


              Please complete one of the options below.

              OR


              (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

              This MUST be an exact figure based on your review of documents submitted with this Claim Form.

              iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

              Please check at least one box.

              Or indicate:

              Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

              File List: No Files Selected

                If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

                The above information is for Tax Year 2000. Please click here to switch to another available Tax Year.

                **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

                4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

                i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

                iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

                If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


                Please complete one of the options below.

                OR


                (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

                This MUST be an exact figure based on your review of documents submitted with this Claim Form.

                iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

                Please check at least one box.

                Or indicate:

                Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

                File List: No Files Selected

                  If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

                  The above information is for Tax Year 2001. Please click here to switch to another available Tax Year.

                  **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

                  4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

                  i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

                  iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

                  If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


                  Please complete one of the options below.

                  OR


                  (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

                  This MUST be an exact figure based on your review of documents submitted with this Claim Form.

                  iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

                  Please check at least one box.

                  Or indicate:

                  Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

                  File List: No Files Selected

                    If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

                    The above information is for Tax Year 2002. Please click here to switch to another available Tax Year.

                    **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

                    4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

                    i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

                    iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

                    If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


                    Please complete one of the options below.

                    OR


                    (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

                    This MUST be an exact figure based on your review of documents submitted with this Claim Form.

                    iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

                    Please check at least one box.

                    Or indicate:

                    Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

                    File List: No Files Selected

                      If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

                      The above information is for Tax Year 2003. Please click here to switch to another available Tax Year.

                      **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

                      4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

                      i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

                      iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

                      If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


                      Please complete one of the options below.

                      OR


                      (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

                      This MUST be an exact figure based on your review of documents submitted with this Claim Form.

                      iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

                      Please check at least one box.

                      Or indicate:

                      Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

                      File List: No Files Selected

                        If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

                        The above information is for Tax Year 2004. Please click here to switch to another available Tax Year.

                        **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

                        4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

                        i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

                        iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

                        If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


                        Please complete one of the options below.

                        OR


                        (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

                        This MUST be an exact figure based on your review of documents submitted with this Claim Form.

                        iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

                        Please check at least one box.

                        Or indicate:

                        Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

                        File List: No Files Selected

                          If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

                          The above information is for Tax Year 2005. Please click here to switch to another available Tax Year.

                          **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

                          4. Please fill out questions (i) through (iv) below for the LLC and Tax Year listed above.

                          i. Did the LLC pay California’s LLC fee (California Form 568, line 2)?

                          iii. Was some or all of that total income derived from a state or states other than California? Please select from either (a), (b), or (c) below and provide additional information based on your selection:

                          If you select “No”, you need not respond to any further questions on this form. Please sign and date the form and return it to the Claims Administrator.


                          Please complete one of the options below.

                          OR


                          (**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)

                          This MUST be an exact figure based on your review of documents submitted with this Claim Form.

                          iv. If the answers to questions 4.ii and/or 4.iii are supported by one or more of the following documents that were prepared on or prior to December 31, 2011 by the LLC, the California key corporation, and/or the combined unitary group, enclose them with this form, as this may affect your refund amount. Indicate which documents you are providing for the specific tax year in question:

                          Please check at least one box.

                          Or indicate:

                          Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

                          File List: No Files Selected

                            If you are having difficulties uploading your supporting documents, please email them directly to info@FTBLLCTaxSettlement.com. Please ensure that you include your claim number in the Subject line of your email. If documentation is required to validate your claim and not received, your claim will be denied.

                            The above information is for Tax Year 2006. Please click here to switch to another available Tax Year.

                            **If the answer to question 4.iii(c) on page 2 is “yes,” the LLC MUST answer “yes” for all other years it submits claims. Additionally, all LLCs included in the same California combined unitary tax return MUST answer “yes” to question 4.iii(c) and may not answer “yes” to question 4.iii(b). Failure to abide by this instruction will result in disqualification of all claims filed by LLCs in the same California combined unitary tax return for all years.

                            STEP 3: ATTESTATION UNDER PENALTY OF PERJURY

                            I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

                            SUBMIT THIS FORM BEFORE JULY 5, 2022.

                            For additional instructions, refer to the Notice of Proposed Settlement or call 1-888-874-5887 with questions.

                            Your Claim Form for Tax Year(s) has been submitted successfully.

                            HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: info@FTBLLCTaxSettlement.com.

                            Please print this page for your records.

                            Your Claim Details

                            Submitted Claim ID:
                            Confirmation Code:
                            You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
                            CLAIM INFORMATION
                            First Name
                            Last Name
                            Phone Number
                            Email Address
                            Signature
                            Date

                            If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at info@FTBLLCTaxSettlement.com