Your name: ______________________________________Your SSN or ITIN: ______________________________
00
28 Amount from Side 1, line 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
00
35 Nonrefundable renter’s credit . (see page 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
00
42 Total tax . Subtract line 35 from line 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
00
43 California income tax withheld (Form(s) W-2, box 17 or CA Sch W-2CG, box 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
43
54 Overpaid tax . If line 43 is larger than line 42, subtract line 42 from line 43 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
54
00
55 Tax due . If line 43 is less than line 42, subtract line 43 from line 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
00
Code
Amount
Code
Amount
Alzheimer’s Disease/Related Disorders Fund . . . . . . . . . . . . . . 401
00
CA Peace Officer Memorial Foundation Fund . 408
00
CA Fund for Senior Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
CA Military Family Relief Fund . . . . . . . . . . 409
00
00
Rare and Endangered Species Preservation Program . . . . . . . . 403
00
CA Sea Otter Fund . . . . . . . . . . . . . . . . . . . . . 410
00
State Children’s Trust Fund for the Prevention of Child Abuse . 404
00
CA Ovarian Cancer Research Fund . . . . . . . 411
00
CA Breast Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . 405
00
Municipal Shelter Spay-Neuter Fund . . . . . 412
00
CA Firefighters’ Memorial Fund . . . . . . . . . . . . . . . . . . . . . . . . . 406
00
CA Cancer Research Fund . . . . . . . . . . . . . 413
00
Emergency Food For Families Fund . . . . . . . . . . . . . . . . . . . . . 407
00
ALS/Lou Gehrig’s Disease Research Fund . 414
00
00
68 Add code 401 through code 414 . These are your total contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
68
69 AMOUNT YOU OWE. Add line 55 and line 68 . (see page 10) Do Not Send Cash.
00
.
,
,
Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001 . . . . . . . . . . . . . . . . .
69
Pay Online – Go to our website at ftb.ca.gov and search for web pay.
73 REFUND OR NO AMOUNT DUE. Subtract line 68 from line 54 .
00
.
,
,
Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0002 . . . . . . . . . . . . . . . . .
73
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 10) .
Have you verified the routing and account numbers? Use whole dollars only .
All or the following amount of my refund (line 73) is authorized for direct deposit into the account shown below:
Checking
00
.
,
,
Savings
Routing number
Type
Account number
74 Direct deposit amount
The remaining amount of my refund (line 73) is authorized for direct deposit into the account shown below:
Checking
00
.
,
,
Savings
Routing number
Type
Account number
75 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.
Sign
Your signature
Spouse’s/RDP’s signature (if filing jointly, both must sign)
Daytime phone number (optional)
(
)
Here
X
X
Date
I
t is unlawful to
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
Paid Preparer’s SSN/PTIN
forge a
spouse’s/RDP’s
signature .
Firm’s name (or yours if self-employed)
Firm’s address
FEIN
Joint return?
(see page 11)
Do you want to allow another person to discuss this return with us (see page 11)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
(
)
Print Third Party Designee’s Name
Telephone Number
Side 2 Short Form 540NR
2008
3142083
C1