FTB 3571 C2 (REV 03-2005) SIDE 1
REQUEST FOR ESTATE
INCOME TAX CLEARANCE CERTIFICATE
As required under California Revenue
and Taxation Code Section 19513
Expedite Request (see instructions)
STATE OF CALIFORNIA
FRANCHISE TAX BOARD
Telephone (916) 845-4210
PLEASE READ INSTRUCTIONS ON SIDE 2 BEFORE COMPLETING THIS FORM
Estate of Federal Employer Id. No. Date of Death
Name of Fiduciary Area Code and Phone No. Decedent’s Social Security No.
Address of Fiduciary (Number and Street) Probate No.
City or Town, State, and ZIP Code County of Probate
Name of Attorney Area Code and Phone No.
Address of Attorney (Number and Street) Mail Tax Clearance Certificate to:
City or Town, State, and ZIP Code
Attorney
Fiduciary
ANSWER THESE QUESTIONS AND FURNISH THE REQUIRED DOCUMENTS
1. Was decedent a resident of the State of California on the date of death? ______________
(If “no,” furnish a copy of the California Estate Tax Return (Form ET-1) and Declaration Concerning Residence (Form IT-2) if filed
with the California State Controller).
2. Have probate proceedings been instituted in any other state? _____________
3. Value of the assets of this estate on date of death. (Please attach federal Form 706.) __________________________
(If not exceeding $1,000,000, you do not need an Estate Income Tax Clearance Certificate. See instructions on Side 2.)
4. Are assets exceeding $250,000 distributable to one or more nonresident beneficiaries? ________________
(If “no,” you do not need an Estate Income Tax Clearance Certificate. See instructions on Side 2.)
5. Has a preliminary distribution been made? _______________
(If “yes,” furnish a copy of the court order authorizing the distribution.)
You must file a return for all taxable years that have ended (even if a return is not yet due), or submit a deposit in
the form of check or bond in an amount to be determined by this office. We require a Specialized Tax Service Fee
for Expedited Estate Income Tax Clearance Certificate Requests. See instructions on Side 2.
DECLARATION REGARDING CALIFORNIA RETURNS FOR DECEDENT AND FOR ESTATE
(To be completed for the four taxable years immediately preceding the date of this request.)
A. DECEDENT
California Individual Income Tax Returns (Form 540, 540A, 540 2EZ, or Long or Short Form 540NR) have been filed by
or on behalf of the decedent for the following years: ________ ________ ________ ________ . If the returns were
not filed for any of the above years, explain in full: _____________________________________________________
_____________________________________________________________________________________________
B. ESTATE
California Fiduciary Income Tax Returns (Form 541) have been filed for the following years:
________ ________ ________ ________ . If fiduciary returns were not filed for any of the last four years during
which the estate was in existence, explain in full: ______________________________________________________
_____________________________________________________________________________________________
I declare, under penalties of perjury, that the information given above is true to the best of my knowledge and belief.
_________________________________________ __________________________________ ___________________
SIGNATURE OF FIDUCIARY OR REPRESENTATIVE TITLE DATE
ALLOW AT LEAST 30 DAYS FOR A RESPONSE TO THIS APPLICATION
FILE AT LEAST 30 DAYS PRIOR TO THE COURT
HEARING ON FINAL ACCOUNT. APPROXIMATE
DATE OF COURT HEARING _____________________
MAIL TO: ESTATE INCOME TAX CLEARANCE CERTIFICATE UNIT MS D-7
FRANCHISE TAX BOARD
PO BOX 1468
SACRAMENTO CA 95812-1468
