State of California
Financial Information System for California (FI$Cal)
GOVERNMENT AGENCY TAXPAYER ID FORM
2000 Evergreen Street, Suite 215
Sacramento, CA 95815
www.fiscal.ca.gov
1-855-347-2250
The principal purpose of the information provided is to establish the unique identification of the government entity.
Instructions:
You may submit one form for the principal government agency and all subsidiaries sharing the same TIN. Subsidiaries with a
different TIN must submit a separate form. Fields bordered in red are required. Hover over fields to view help information. Please print the
form to sign prior to submittal. You may email the form to: vendors@fiscal.ca.gov, or fax it to (916) 576-5200, or mail it to the address above.
Principal
Government
Agency Name
Remit-To
Address (Street
or PO Box)
City
Government Type:
State Zip Code+4
County
Federal
Employer
City
Special District Federal
Identification
Other (Specify)
Number
(FEIN)
List other subsidiary Departments, Divisions or Units under your principal agency's jurisdiction who share the same
FEIN and receives payment from the State of California.
Dept/Division/Unit Complete
Name Address
Dept/Division/Unit Complete
Name Address
Dept/Division/Unit Complete
Name Address
Dept/Division/Unit Complete
Name Address
Contact Person Title
Phone number E-mail address
Signature Date
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