Form 540 2ez - California Resident Income Tax Return - 2011 Page 2
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Your name: ____________________________ Your SSN or ItIN: _________________________
0
Overpaid
21a Enter the amount from Side 1, line 21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21a
.
,
0 0
Tax/
22
total tax withheld (federal Form W-2, box 17
Tax Due
.
or Form 1099-R, box 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
.
,
0 0
0
.
23
overpaid tax. If line 22 is more than line 21a, subtract line 21a from line 22 . . . . . . . .
23
,
0 0
24
tax due. If line 22 is less than line 21a, subtract line 22 from line 21a.
0
.
See instructions, page 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
,
0 0
25
Use tax. This is not a total line. See instructions, page 8 .
25
.
,
0 0
Use Tax
Voluntary Contributions
Code
Amount
Code
Amount
00
CA Peace Officer Memorial Foundation Fund
408
00
CA Seniors Special Fund. See page 11 . . .
400
CA Sea Otter Fund . . . . . . . . . . . . . . . . . . . .
410
00
00
Alzheimer’s Disease/Related Disorders Fund
401
Municipal Shelter Spay-Neuter Fund . . . . .
412
00
CA Fund for Senior Citizens . . . . . . . . . . . .
402
00
00
Rare and Endangered Species
CA Cancer Research Fund . . . . . . . . . . . .
413
Preservation Program . . . . . . . . . . . . . . .
403
00
00
ALS/Lou Gehrig’s Disease Research Fund
414
State Children’s Trust Fund for the
Arts Council Fund. . . . . . . . . . . . . . . . . . . .
415
00
Prevention of Child Abuse. . . . . . . . . . . .
404
00
CA Police Activities League (CALPAL) Fund
416
00
CA Breast Cancer Research Fund . . . . . . .
405
00
00
CA Veterans Homes Fund . . . . . . . . . . . . .
417
00
CA Firefighters’ Memorial Fund . . . . . . . . .
406
00
Safely Surrendered Baby Fund . . . . . . . . .
418
00
Emergency Food For Families Fund. . . . . .
407
Child Victims of Human Trafficking Fund . .
419
00
0
.
26 Add amounts in code 400 through code 419. these are your total contributions . . . . . . .
26
,
0 0
27 AMOUNT YOU OWE. Add line 24, line 25, and line 26. If line 23 is less than line 25 and
Amount
You Owe
line 26, enter the difference here. See instructions, page 9 (Do Not Send Cash). Mail to:
0
FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001 . . . . . . . .
27
.
,
0 0
Pay online – Go to ftb.ca.gov and search for web pay.
Direct
28 REFUND OR NO AMOUNT DUE. Subtract line 25 and line 26 from line 23. See
Deposit
(Refund
instructions, page 9. Mail to: FRANCHISE TAX BOARD, PO BOX 942840,
Only)
0
.
SACRAMENTO CA 94240-0002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
,
0 0
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. Have you verified the routing and
account numbers? Use whole dollars only.
All or the following amount of my refund (line 28) is authorized for direct deposit into the
account shown below:
m Checking
.
,
m Savings
0 0
29 Direct deposit amoun
Routing number
type
Account number
t
the remaining amount of my refund (line 28) is authorized for direct deposit into the
account shown below:
m Checking
.
,
0 0
m Savings
30 Direct deposit amount
Routing number
type
Account number
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the information on this return is true, correct, and complete.
Your signature
Spouse’s/RDP’s signature (if filing jointly, both must sign)
Daytime phone number (optional)
Sign Here
(
)
It is unlawful
to forge a
X
X
Date
spouse’s/RDP’s
Your email address (optional). Enter only one email address.
signature.
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
PtIN
Joint return?
See instructions,
page 10.
Firm’s name (or yours if self-employed)
FEIN
Firm’s address
m
m
Do you want to allow another person to discuss this return with us (see page 10)? . . . . . . . . . .
Yes
No
(
)
__________________________________________________________________
__________________________________
Print Third Party Designee’s Name
Telephone Number
Side 2
Form 540 2EZ
2011
8
C1
3112113
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