California Adjustments —
SCHEDULE
TAXABLE YEAR
CA (540NR)
Nonresidents or Part-Year Residents
2012
Important: Attach this schedule behind Long Form 540NR, Side 3 as a supporting California schedule.
Name(s) as shown on tax return
SSN or ITIN
Part I Residency Information . Complete all lines that apply to you and your spouse/RDP .
During 2012:
Yourself
Spouse/RDP
▌
▌
1 a I was domiciled in (enter state or country) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
______________________
▌
▌
b I was in the military and stationed in (enter state or country) . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
______________________
▌
▌
2 I became a California resident (enter the state of prior residence and date of move) . . . . . . . . .
_____________________
______________________
▌
▌
3 I became a nonresident (enter new state of residence and date of move) . . . . . . . . . . . . . . . . .
_____________________
______________________
▌
▌
4 I was a nonresident of California the entire year (enter state or country of residence). . . . . . . .
_____________________
______________________
▌
▌
5 The number of days I spent in California (for any purpose) is: . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
______________________
▌
▌
6 I owned a home/property in California (enter “Yes” or “No”) . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
______________________
Before 2012:
▌
▌
7 I was a California resident for the period of (enter dates). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
______________________
▌
▌
8 I entered California on (enter date). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
______________________
▌
▌
9 I left California on (enter date) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_____________________
______________________
Part II Income Adjustment Schedule
A
B
C
D
E
Section A — Income
Federal Amounts
Subtractions
Additions
Total Amounts
CA Amounts
Using CA Law
(taxable amounts from
See instructions
See instructions
(income earned or
As If You Were a
your federal tax return)
(difference between
(difference between
received as a CA
CA Resident
CA & federal law)
CA & federal law)
resident and income
(subtract col. B from
earned or received
col. A; add col. C
from CA sources
to the result)
as a nonresident)
7 Wages, salaries, tips, etc. See instructions
▌
▌
▌
▌
▌
before making an entry in col. B or C. . . . . . 7
▌
▌
▌
▌
▌
8 Taxable interest. (b) ________________ . . 8(a)
9 Ordinary dividends. See instructions.
▌
▌
▌
▌
▌
▌
(b)
. . . . . . . . . . . . . . . . 9(a)
10 Taxable refunds, credits, or offsets of state
▌
▌
and local income taxes. . . . . . . . . . . . . . . . . 10
▌
▌
▌
▌
11 Alimony received. See instructions . . . . . . 11
▌
▌
▌
▌
▌
12 Business income or (loss) . . . . . . . . . . . . . . 12
▌
▌
▌
▌
▌
13 Capital gain or (loss). See instructions. . . . . 13
▌
▌
▌
▌
▌
14 Other gains or (losses) . . . . . . . . . . . . . . . . 14
15 IRA distributions. See instructions.
▌
▌
▌
▌
▌
▌
(a)
. . . . . . . . . . . . . . . 15(b)
16 Pensions and annuities. See
▌
▌
▌
▌
▌
▌
instructions. (a)
. . . . 16(b)
17 Rental real estate, royalties, partnerships,
▌
▌
▌
▌
▌
S corporations, trusts, etc.. . . . . . . . . . . . . . 17
▌
▌
▌
▌
▌
18 Farm income or (loss) . . . . . . . . . . . . . . . . . 18
▌
▌
19 Unemployment compensation . . . . . . . . . . . 19
▌
▌
▌
20 Social security benefits. (a)
20(b)
21 Other income.
{
▌
a California lottery winnings
a
a _____________
▌
b Disaster loss carryover from FTB 3805V
b
b _____________
▌
c Federal NOL (Form 1040, line 21)
c _____________ c
▌
▌
▌
▌
d NOL carryover from FTB 3805V
21
d
d _____________
21
21
e NOL from FTB 3805D, FTB 3805Z,
▌
FTB 3806, FTB 3807, or FTB 3809
e
e _____________
▌
▌
f Other (describe):___________________
f
f
________________________________
22 a Total: Combine line 7 through line 21
▌
▌
▌
▌
▌
in each column. Continue to Side 2 . . . . . 22a
Schedule CA (540NR) 2012 Side 1
7741123
For Privacy Notice, get form FTB 1131.