Franchise Tax Board (FTB) Assistance Form

Contact Information

First Name *

Last Name *

Address *

City *

Zip Code *

Phone Number

Ext.

Phone Number Type

Reason for Request

What do you need assistance with?

Personal Income Tax: Please provide FTBID (10-digit number located on any FTB notice addressed to the taxpayer)

Business Entity Income Tax: Please provide (1) Name of Business Entity and (2) CA Corporation Number, CA LLC Number, or Federal ID

Non Tax Debt Collection - Delinquent Vehicle Registration: Please provide Vehicle Registration Collections (VRC) Account Number

Non Tax Debt Collection - Delinquent Court Ordered Debt: Please provide Court-Ordered Debt (COD) Account Number

Briefly describe the issue you are having. *

Have you already contacted another elected official for assistance with this issue? *

Yes

If Yes, please list any other elected officials you have contacted.

Last 4 digits of your Social Security Number *

Authorization for Release of Information

Please carefully read the following:

By completing this form, I am requesting the Office of Assemblymember Bryan (the “Assemblymember”) to assist me in working with the Franchise Tax Board (FTB) on my request. I acknowledge that this may require the release of information contained in my records the dissemination of which may be prohibited by law. Therefore, I hereby authorize FTB and the Assemblymember to share all relevant portions of my records with each other, and to discuss matters relating to those records and my request for assistance, until my request is resolved.

I agree that I will not submit any personal identifiable information through this form that is not specifically requested. If the Assemblymember’s office needs additional information the office will contact me to request that information. *

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