Form 4803e - Head Of Household Schedule - 2005 (Page 2 of 2) in pdf

DO NOT MAIL THIS FORM TO FTB

7. If your qualifying person did not live with you for the entire year during 2005, select the code below that

best explains the main reason your qualifying person was absent from your home. Enter the code letter

in the code box to the right.

Main Reason

Code

Lived away at school

Military service

Hospital / Convalescence

Birth or death

College

Lived with other parent

Code

Moved out

Other (please explain) __________________

8. If your qualifying person was a foster child, was the child placed in your home by an authorized

placement agency or by a judgment, decree, or other order of a court?

Yes

If yes, what is the name of the placement agency or court that ordered the placement? _______

___________________________________

9 Was your qualifying person in question 1 married as of December 31, 2005?

Yes

If yes, did this person file a joint tax return for 2005 with his or her spouse?

Yes

10. Was your qualifying person a citizen of the U.S. or a resident of the U.S., Canada, or Mexico?

Yes

11.As of December 31, 2005, were you single? For the purpose of this question “single” means: never

legally married, or widowed (spouse died before January 1, 2005), or received a final court decree of

divorce or legal separation on or before December 31, 2005, or received a final court decree of

annulment.

Yes

12 If you were legally married during all or part of 2005, did you live with your spouse at any time during

that year? You were legally married in 2005 if you did not receive a final court decree of divorce or legal

separation on or before December 31, 2005, or did not receive a final court decree of annulment.

Yes

Not Applicable

If yes, list the beginning and ending dates of each period that you lived with your spouse during 2005.

From

Please provide a telephone number and the best time we can reach you between 6:30 a.m. and 7 p.m.

Monday through Friday, if we need more information.

____-___-____-____

Best time to call: _______________________ Telephone number:

(Area Code) (Number)

(Extension)

Form 4803e - Head Of Household Schedule - 2005 Page 2