Ftb form 4107-2026

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The document is a form from the California Franchise Tax Board for taxpayers to request a discontinuation or waiver of the mandatory electronic payment (e-Pay) requirement. It outlines eligibility criteria for waivers based on tax liability and physical or mental impairments, and includes sections for personal information, reasons for the request, and necessary signatures. Additionally, it provides instructions for submitting the form and details about required physician affidavits for those claiming permanent impairments.

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Click ‘Get Form’ to open the ftb form 4107 in the editor.
Begin by entering your name and Social Security Number at the top of the form. If applicable, include your spouse or Registered Domestic Partner's information.
In Part 1, select one of the options to either discontinue mandatory e-pay election or request a waiver. Make sure to provide any necessary explanations if required.
If you are requesting a waiver due to a permanent physical or mental impairment, complete Part 2 and ensure that you attach a signed physician affidavit as instructed.
In Part 3, both taxpayers must sign and date the form. Include your telephone numbers for contact purposes.
Once completed, save your changes and submit the form via mail or fax as indicated on the document.

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