Ftb 3552 Form PDF Details

If you believe that someone has used your personal information to file a fraudulent tax return or to commit other fraud, you can use Form FTB 3552 to report the identity theft to the FTB. This form allows you to provide the FTB with information about the fraudulent activity, including the date you first became aware of the identity theft and any steps you have taken to try to resolve the issue.

IRS Form 14039 and FTB Form 3552 are both used to report cases of identity theft, but they are used by different tax authorities and for slightly different purposes.

QuestionAnswer
Form Name FTB Form 3552
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names form 3552, ftb 3552, ftb identity affidavit form, identify affidavit

Form Preview Example

STATE OF CALIFORNIA

FILING COMPLIANCE BUREAU MS F151

FRANCHISE TAX BOARD

PO BOX 1468

SACRAMENTO CA 95812-1468

Identity Theft Affidavit

Complete and submit this form if you are an actual or potential victim of identity theft and would like the Franchise Tax Board (FTB) to update your account status to identify questionable activity.

Check one of the following boxes:

I am a victim of identity theft, and I believe this incident is affecting my tax account. Provide a short explanation of the tax impact:

I am a victim of identity theft, and I believe I may be at risk for future impact to my tax account.

I am a potential victim of identity theft, and I believe I may be at risk for future impact to my tax account. (Check “potential victim” if you have not experienced identity theft but are at risk due to a lost/stolen purse or wallet, questionable credit card or credit report activity, etc.)

Tax Year(s) Impacted

Date the Incident Occurred

Last Tax Return Filed (Year)

Provide the last 4 digits of your Social Security Number or

(if applicable or known):

(if applicable or known):

(Enter NRF if Not Required to File.):

your complete Individual Taxpayer Identification Number:

 

 

 

 

 

Last Name:

 

First Name:

 

Middle Initial:

 

 

 

 

 

Current Mailing Address:

 

 

 

 

City:

State:

 

 

Address on Last Tax Return Filed (Check Here If You Are Not Required to File a Tax Return.):

ZIP Code:

City:

State:

ZIP Code:

 

 

 

 

Telephone Number: Home Work Cell

Best Time (s) to Call:

Primary Language: English Spanish Other

 

 

Specify:

 

 

 

 

 

Under penalty of perjury, I declare that, to the best of my knowledge and belief, the information entered in this form is true, correct, complete, and made in good faith. I hereby agree and consent that the facsimile/fax signature of this affidavit shall be considered as valid as the original.

Taxpayer Signature

Date Signed (mm/dd/yyyy)

Submit this completed form and a copy of at least one of the following documents to verify your identity.

(Check the box next to the document you are submitting.)

a) Passport

b) Driver license or Department of Motor Vehicles identification card

If available, include a copy of:

c) Social security card

d) Police report

e) Internal Revenue Service letter of determination

Submit the copies required above with this form using one of the options described on PAGE 2 of this form.

FTB 3552 (REV 06-2016) C1 PAGE 1

355200081371

Submit the copies required above with this form using one of the options described on PAGE 2 of this form.

By Mail:

By Fax:

 

 

If you received a notice from FTB, return this

If you received a notice in the mail from FTB and a fax

form with a copy of the notice to the address

number is shown, fax this completed form with a copy of

contained in the notice.

the notice to that number. Include a cover sheet marked

 

“Confidential.” If no fax number is shown, follow the mailing

If you have not received an FTB notice and are

instructions.

self-reporting potential risk for future impact to

 

your tax account, mail this form to:

FTB does not initiate contact with taxpayers by email or fax.

FILING COMPLIANCE BUREAU MS F151

If you have not received an FTB notice and are self-reporting

FRANCHISE TAX BOARD

potential risk for future impact to your tax account, fax this form

PO BOX 1468

to:

SACRAMENTO CA 95812-1468

 

 

916.843.0561

 

 

Go to oag.ca.gov and search for identity theft for additional resources and information regarding identity theft.

For privacy information, go to ftb.ca.gov and search for privacy notice. To request this notice by mail, call 800.338.0505 and enter form code 948 when instructed.

Connect With Us

Web: ftb.ca.gov

Phone:

916.845.7088

 

7 a.m. to 5 p.m. weekdays, except state holidays

 

 

916.845.6500

 

from outside the United States

 

 

 

TTY/TDD: 800.822.6268

for persons with hearing or speech impairments

FTB 3552 (REV 06-2016) C1 PAGE 2

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Be mindful while filling out this form. Make certain every single field is filled in properly.

1. The form 3552 ftb will require specific details to be typed in. Be sure that the following fields are complete:

Find out how to complete are form 3552 part 1

2. Soon after this selection of blanks is done, go to enter the suitable information in all these: Telephone Number Home Work Cell, Primary Language English Spanish, Under penalty of perjury I declare, Taxpayer Signature, Date Signed mmddyyyy, Specify, Submit this completed form and a, Check the box next to the document, If available include a copy of c, Submit the copies required above, and FTB REV C PAGE.

are form 3552 completion process explained (portion 2)

Concerning Under penalty of perjury I declare and Specify, make certain you double-check them in this current part. Those two are thought to be the most significant ones in this form.

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