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Form 3567 Installment Agreement Request

Form 3567 Installment Agreement Request

Form 3567 Installment Agreement Request

 

INSTRUCTIONS: CALIFORNIA INSTALLMENT AGREEMENT REQUEST (Form FTB 3567)

 

 

Those who owe tax in California and are unable to pay the full balance at once may file a form FTB 3567 to request that an installment payment plan be created. You are qualified to make this request if you do not owe more than $25,000 in state tax liability, you do not request more than 60 months to complete your installment payments, you have filed all required personal income tax returns and you are not already in an existing installment agreement. This form is found on the website of the state's Franchise Tax Board.

 

California Installment Agreement Request FTB 3567 Step 1: Enter your name and Social Security or FTB identification number on the first line.

 

California Installment Agreement Request FTB 3567 Step 2: If you file taxes jointly or with a spouse, enter their information on the second line.

 

California Installment Agreement Request FTB 3567 Step 3: Below this, enter your current home address, home and work phone number, and the work phone number of your spouse if applicable.

 

California Installment Agreement Request FTB 3567 Step 4: In Box 1, enter the amount of the payment you will make every month.

 

California Installment Agreement Request FTB 3567 Step 5: In Box 2, enter the date on which you will submit this payment. This cannot be after the 28th of the month.

 

California Installment Agreement Request FTB 3567 Step 6: If the liability you owe is in excess of $10,000 or you require more than 36 months to complete your payments, check the box on the next line to certify that you have a financial hardship.

 

California Installment Agreement Request FTB 3567 Step 7: Sign and print your name where indicated. Enter your phone number and the date.

 

California Installment Agreement Request FTB 3567 Step 8: If you wish to make payments via an automatic monthly withdrawal from your bank account, complete the section below considering giving an Electronic Funds Transfer (EFT) authorization. Give your bank's name and address, your account and routing number, and indicate with a check mark whether this is a checking or savings account.

 

California Installment Agreement Request FTB 3567 Step 9: You must print and sign your name again at the bottom of the form to authorize this transaction.

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