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Get and Sign Ftb3900a Form
(If the answer is No, then
this form does not apply.)
Claimant
First Name
MI
Last Name
Phone Number
SSN, ITIN, or FTB ID (if claimant is the taxpayer to whom the stale-dated warrant was initially issued)
Street Address (number and street) or PO Box
City
State
ZIP Code
Email Address
Claim Information
Dollar Amount of Stale-Dated Warrant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________
Stale-Dated Warrant Issue Date...
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