FTB 3557 BC Application For Certificate Of Revivor Corporation 3557BC

User Manual: 3557

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FTB 3557 BC (REV 03-2015)

Before the California Franchise Tax Board

In the matter of the application for certificate of revivor of:

Entity Name:

Address:

I request relief from suspension or forfeiture for this entity. I previously submitted or I am enclosing all required

payments, returns, or documents.

Print Name _____________________________________ Title ________________________________

Signature ______________________________________ Date ________________________________

Daytime Phone Number ___________________________

Those who can sign this application on behalf of an entity (domestic or foreign) include:

• Any stockholder, creditor, member, general partner, or officer.

• Any person having an interest in relief from suspension or forfeiture.

Domestic entities can also have a majority of the surviving trustees or directors sign on their behalf.

Entity Number:

FEIN:

SOS Number:

STATE OF CALIFORNIA

FRANCHISE TAX BOARD

PO BOX 942857

SACRAMENTO CA 94257-0511

Application for Certificate of Revivor – Corporation

Notice Date:

355747071371

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