
Request for Chief Counsel to Relieve Penalties
Please see the reverse side of this form for general instructions and mailing information.
Use this form to request relief from a penalty imposed under Revenue and Taxation Code Sections 19164.5,
19173, 19179, 19182, 19772, 19773, or 19774. You must complete a separate FTB 626 for each penalty
from which you want relief.
Name of Taxpayer/Entity Social Security Number/Entity ID Number
Spouse/RDP Spouse’s/RDP’s Social Security Number
Address (number, street, and room, or suite number) City, State, and ZIP Code
Tax Year (if applicable) Amount of Penalty
I request that Franchise Tax Board’s Chief Counsel relieve the following penalty: (Check only one.
You must submit a separate claim for each penalty from which you want relief. )
Section 19164.5 - Reportable transaction accuracy-related penalty
Section 19173 - Failure to maintain advisee lists penalty
Section 19179 - Frivolous return penalty
Section 19179(d) - Frivolous submission penalty
Section 19182 - Failure to furnish information regarding reportable transactions
Section 19772 - Failure to disclose reportable transaction penalty
Section 19773 - Reportable transaction understatement penalty
Section 19774 - Noneconomic substance transaction understatement penalty
I attached a statement specifying the facts and reasons supporting my request for relief from the
selected penalty.
Under penalties of perjury, I declare that I have examined this request, including any accompanying
schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature (and title if applicable) Date
Signature Date
Get FTB 1131, Franchise Tax Board Privacy Notice, at ftb.ca.gov or call us at 800.338.0505 and select form
code 948 when prompted. If outside the United States, call us at 916.845.6500.
FTB 626 C2 (REV 06-2016) SIDE 1