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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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)?
Yes
No
If yes, the amount paid
ii. What was the LLC’s total income (California Form 568, line 1)?
This is an exact figure based on my review of documents submitted with this Claim Form.
This is an estimate because I no longer have copies of the relevant documents.
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:
(a) No.
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.
(b) Yes, because the LLC had some or all of its property, payroll, or sales outside of California.
(c) Yes, because some or all of the LLC’s income was included in a combined unitary tax return of a California taxpayer that had some or all of its property, payroll, or sales outside of California
(**IF YOU ANSWERED “YES,” SEE ADDITIONAL INSTRUCTION BELOW.)
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.
Limited Liability Company Income Worksheet
Document Date
California Schedule R, including all schedules
Document Date
California Schedule D (568)
Document Date
California 565 Rec (Reconciliation of CA Source Amount)
Document Date
California Form K-1
Document Date
Other document showing percentage of non-California apportionment of income
Document Date
Document Description
Or indicate:
I do not have any of these documents for the relevant tax year.
Tax Year *
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.
Select File for Upload:
File Description:
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.