CA FTB 3561 BKLT 2014-2025 free printable template

The lien may appear on your credit record. FTB 3561 BKLT FILLABLE C2 REV 07-2014 PAGE 1 Please furnish the information requested on this form. It is important that all questions are answered. If you run out of space please attach additional pages write your name and social security number on all additional pages. State of California Franchise Tax Board 3561 BOOKLET Installment Agreement You may be eligible to make monthly installment payments if you have a financial hardship and cannot pay your...tax amount in full. If we approve your request we agree to let you pay the tax amount you owe in monthly installments instead of immediately paying the amount in full. You must make your monthly payments through electronic funds transfer EFT. EFT allows you to automatically make payments to the Franchise Tax Board by a direct transfer of funds from your checking or savings bank account. When you request an installment agreement you agree to meet all future tax liabilities. You must file your...future returns timely and have enough withholding or estimated tax payments to pay your tax liability in full for future years. You will be in default on your agreement if you do not make your payments on time or if you have an outstanding past due amount in a future year. We may take collection actions to collect the entire amount you owe. Please check your W-4 or DE-4 on file with your employer to be sure that your withholding rate is correct. If you have income from other sources be sure that...your estimate payments are adequate. What you should know if you are approved for an installment agreement We will automatically deduct your payments from your bank account. Additional interest and some penalties continues to accrue while you make your scheduled payments. You must contact your employer to adjust your W-4 form to ensure that your tax is covered each year. You may need to change your W-4 form to ensure enough money is being withheld to pay any future tax. We will keep offset any...state tax refund you are due and deduct it from the total amount you owe. This offset will not replace your monthly payment. We may file a state tax lien to protect the state s interest until you pay off your balance Government Code Section 7170-7173. All information will be verified* 1. Taxpayer Information Name Home Telephone Number Work Telephone Number Address Spouse s Work Phone Number Personal Fax Number Taxpayer s Social Security Number Spouse s Social Security Number Taxpayer s Date of...Birth Spouse s Date of Birth City State ZIP / 2. List all dependents and non-relatives living with you Age 3. Employment Information Taxpayer Relationship Spouse Employer/ Business Name Business Name Address Address Employer/Business Tel Number Employer/Business Tel Number Occupation/Profession Occupation/Profession How long employed How long employed Marital Status on your W-4 Marital Status on your W-4 Number of exemptions you claim Number of exemptions you claim 4. Bank Accounts Includes...Savings Loans Credit Unions IRA s Name of Institution Type of Account Checking/Savings Joint/Separate Account Number Balance Total E 5.