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Begin by selecting the appropriate box indicating your status as a victim or potential victim of identity theft. Provide a brief explanation of how this incident has impacted your tax account if applicable.
Fill in the 'Tax Year(s) Impacted' and 'Date the Incident Occurred' fields, if known. If you have not filed a tax return, enter 'NRF' in the last tax return filed section.
Complete your personal information including your last name, first name, middle initial, and the last four digits of your Social Security Number or Individual Taxpayer Identification Number.
Enter your current mailing address and check the box if you are not required to file a tax return. Include your telephone number and preferred contact times.
Sign and date the affidavit under penalty of perjury, ensuring all information is accurate.
Select and attach copies of required documents for identity verification before submitting via mail or fax as instructed on PAGE 2 of the form.
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Please login with your primary email and contact an Enrollment Counselor if you have questions. Forgot username or password? Login. New to Capella?Read more
Complete and submit this form if you are an actual or potential victim of identity theft and would like the Franchise Tax. Board (FTB) to update your accountRead more
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