Form 540nr - California Nonresident Or Part-Year Resident Income Tax Return - Short Form - 2011 Page 2

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Your name: ______________________________________Your SSN or ITIN: ______________________________
00
50 Amount from Side 1, line 42 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
00
61 Nonrefundable renter’s credit . (see page 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
61
00
74 Total tax . Subtract line 61 from line 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
74
00
81 California income tax withheld (Form(s) W-2, box 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
81
103 Overpaid tax . If line 81 is larger than line 74, subtract line 74 from line 81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
103
00
00
104 Tax due . If line 81 is less than line 74, subtract line 81 from line 74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Code
Amount
Code
Amount
Alzheimer’s Disease/Related Disorders Fund . . . . . 401
00
California Sea Otter Fund . . . . . . . . . . . . . . . . . . . . 410
00
California Fund for Senior Citizens . . . . . . . . . . . . . 402
00
Municipal Shelter Spay-Neuter Fund . . . . . . . . . . . . 412
00
Rare and Endangered Species
California Cancer Research Fund . . . . . . . . . . . . . . 413
00
Preservation Program . . . . . . . . . . . . . . . . . . . . . 403
00
ALS/Lou Gehrig’s Disease Research Fund . . . . . . . . 414
00
State Children’s Trust Fund for the Prevention
Arts Council Fund . . . . . . . . . . . . . . . . . . . . . . . . . . 415
00
of Child Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
00
California Police Activities League
California Breast Cancer Research Fund . . . . . . . . . 405
(CALPAL) Fund . . . . . . . . . . . . . . . . . . . . . . . . . . 416
00
00
California Firefighters’ Memorial Fund . . . . . . . . . . 406
00
California Veterans Homes Fund . . . . . . . . . . . . . . . 417
00
Emergency Food for Families Fund . . . . . . . . . . . . . 407
00
Safely Surrendered Baby Fund . . . . . . . . . . . . . . . . 418
00
California Peace Officer Memorial
Child Victims of Human Trafficking Fund . . . . . . . . 419
00
Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . . 408
00
00
120 Add code 401 through code 419 . This is your total contribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
120
121 AMOUNT YOU OWE. Add line 104 and line 120 . (see page 10) Do Not Send Cash.
00
.
,
,
Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001 . . . . . . . . . . . . . . .
121
Pay Online – Go to ftb.ca.gov and search for web pay.
125 REFUND OR NO AMOUNT DUE. Subtract line 120 from line 103 .
00
.
,
,
Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0002 . . . . . . . . . . . . . . .
125
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 125) is authorized for direct deposit into the account shown below:
Checking
00
.
,
,
Savings
Routing number
Type
Account number
126 Direct deposit amount
The remaining amount of my refund (line 125) is authorized for direct deposit into the account shown below:
Checking
00
.
,
,
Savings
Routing number
Type
Account number
127 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
t is unlawful to
I
Your email address (optional) . Enter only one email address .
forge a
spouse’s/RDP’s
signature .
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
PTIN
Joint tax return?
(see page 11)
Firm’s name (or yours if self-employed)
Firm’s address
FEIN
 
Do you want to allow another person to discuss this tax return with us? (see page 11) . . . . . . .
Yes
No
(
)
__________________________________________________________________
__________________________________
Print Third Party Designee’s Name
Telephone Number
Side 2 Short Form 540NR
2011
C1
3142113

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