Fillable Printable Ftb 3607 - Check Casher Information Return Waiver Request

Ftb 3607 - Check Casher Information Return Waiver Request

Waiver Request Form

FTB 3607 (REV 09-2007)

Use this form to request a waiver from reporting check casher transactions in 2007 calendar year. Waiver requests must

be postmarked no later than March 31, 2008. If we approve your 2007 calendar year reporting waiver request, you are

expected to report your information in 2008. Generall y, we will mail or fax you an approved copy of your waiver requestfor

your records within 45 days of the date we receive it.

Please contact our call center if you have any questions a bout information reporting.

Telephone: (916) 845-6304 Mail to:

Fax Number: (916) 845-0412

CHECK CASHER INFORMATION REPORTING MS A181

Email Address: ckcash[email protected].gov

FRANCHISE TAX BOARD

Hours of Operation: 7 a.m. to 4 p.m. PO BOX 1468

SACRAMENTO CA 95812-1468

Part I Check Casher Information

1. Business Name 2. FEIN 3. SEIN 4. DOJ Permit Number

5. Street Address 6. Suite Number

7. City 8. State 9. Zip

10. Telephone Number 11. FAX Number

Part II Waiver Request(Check the appropriate box.)

12. I request a waiver from reporting the required transactions for 2007 due to the follo wing:

I am unable to report the required transaction information due to inadeq uate computer resources.

I am unable to report the required transaction informatio n be cause I was unable to make the necessary modifications t o

my existing system in time to comply with the 2007 calendar year reporting requirements.

Note: Even if a waiver is granted for information reporting for 2007, I agree to maintain the data for five years.

Check Casher Transaction Information (Complete the following questionnaire)

13. Approximately how many of your customers presented checks in the calendar year 2007 which totaled over $10,000?

1 – 100 101 – 250 250 – 500 More than 500

Authorized Representative

Under penalty of perjury of the laws of the State of California, I declare that I have examined this form, including any accompanying

statements, and to the best of my knowledge and belief it is true, correct, and complete.

Name (Please print) __________________________________ _______ Title _________ _________________________________

Signature ___________ _____________________________ ___________ Date ________________________________

STATE OF CALIFORNIA

CHECK CASHER INFORMATION REPORTING MS A181

FRANCHISE TAX BOARD

PO BOX 460

RANCHO CORDOVA CA 95741-0460

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