Form 540a - California Resident Income Tax Return - 2010 Page 2

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Your name: ______________________________________Your SSN or ITIN: ______________________________
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00
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70 Enter the amount from Side 1, line 64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
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00
71 California income tax withheld (see page 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
71
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72 2010 CA estimated tax and other payments (see page 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
72
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74 Excess SDI (or VPDI) withheld (see page 13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
74
Child and Dependent Care Expenses Credit (see page 13) . Attach form fTB 3506 .
75 Qualifying person’s social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
75_______-_____-________
76 Qualifying person’s social security number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
76_______-_____-________
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77 Enter the amount from form fTB 3506, Part III, line 8 . . . . . . . . . . . . . . . . . . . . . .
77
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78 Child and Dependent Care Expenses Credit from form fTB 3506, Part III, line 12 . . . . . . . . . . . . . . . . . . . . . .
78
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79 Add line 71, line 72, line 74, and line 78 . These are your total payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
00
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91 Overpaid tax . If line 79 is more than line 70, subtract line 70 from line 79 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
00
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92 Amount of line 91 you want applied to your 2011 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
92
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93 Overpaid tax available this year . Subtract line 92 from line 91 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
93
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94 Tax due . If line 79 is less than line 70, subtract line 79 from line 70 . (see page 14) . . . . . . . . . . . . . . . . . . . . . . . .94
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95 Use Tax . This is not a total line . (see page 14) . . . . . . . . . .
95
Code
Amount
Code
Amount
00
00
CA Seniors Special fund (see page 22) . . . . . . . . . . . . . . . . . . .
400
CA Peace Officer Memorial foundation fund . .
408
00
00
Alzheimer’s Disease/Related Disorders fund . . . . . . . . . . . . . . .
401
CA Sea Otter fund . . . . . . . . . . . . . . . . . . . . .
410
00
00
CA fund for Senior Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . .
402
CA Cancer Research fund . . . . . . . . . . . . . .
413
00
00
Rare and Endangered Species Preservation Program . . . . . . . . .
403
Arts Council fund . . . . . . . . . . . . . . . . . . . . .
415
00
00
State Children’s Trust fund for the Prevention of Child Abuse . .
404
CA Police Activities League (CALPAL) fund
416
00
00
CA Breast Cancer Research fund . . . . . . . . . . . . . . . . . . . . . . . .
405
CA Veterans Homes fund . . . . . . . . . . . . . . .
417
00
00
CA firefighters’ Memorial fund . . . . . . . . . . . . . . . . . . . . . . . . . .
406
Safely Surrendered Baby fund . . . . . . . . . . .
418
00
Emergency food for families fund . . . . . . . . . . . . . . . . . . . . . .
407
00
110 Add code 400 through code 418 . This is your total contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
110
111 AMOUNT YOU OWE. Add line 94, line 95, and line 110 (see page 15) . Do not send cash.
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Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001 . . . . . . . . . . . . . .
111
Pay Online – Go to ftb.ca.gov and search for web pay.
 
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113 Underpayment of estimated tax . If form fTB 5805 is attached, fill in this circle . . . . . . . . . . . . . . .
113
115 REFUND or NO AMOUNT DUE. Subtract line 95 and line 110 from line 93 (see page 16) .
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Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0002 . . . . . . . . . . . . . .
115
fill in the information to authorize direct deposit of your refund into one or two accounts . Do not attach a voided check or a deposit slip (see page 16) .
Have you verified the routing and account numbers? Use whole dollars only .
All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below:
 Checking
00
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 Savings
Routing number
Type
Account number
116 Direct deposit amount
The remaining amount of my refund (line 115) is authorized for direct deposit into the account shown below:
 Checking
00
.
 Savings
,
,
Routing number
Type
Account number
117 Direct deposit amount
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete .
Your signature
Spouse’s/RDP’s signature (if filing jointly, both must sign)
Daytime phone number (optional)
Sign
(
)
Here
X
X
Date
Your email address (optional) . Enter only one email address .
It is unlawful to
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
Paid preparer’s PTIN/SSN
forge a spouse’s/RDP’s
signature .
firm’s name (or yours, if self-employed)
firm’s address
fEIN
Joint tax return?
(see page 17)
 Yes  No
Do you want to allow another person to discuss this return with us (see page 17)? . . . . . . . . . . . .
(
)
__________________________________________________________________
__________________________________
Print Third Party Designee’s Name
Telephone Number
Side 2 form 540A
2010
C1
3122103

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