Form 8454 - E-File Opt-Out Record For Individuals - 2012

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DO NOT MAIL THIS FORM TO THE FTB
TAXABLE YEAR
CALIFORNIA FORM
e-file Opt-Out Record for Individuals
8454
General Information
California law requires individual income tax returns prepared by certain income tax preparers to be electronically filed
(e-filed) unless the taxpayer elects not to e-file or the tax preparer cannot e-file the return due to reasonable cause. Use
this form to record when and why the return was not e-filed.
Do not mail this form to FTB. Please keep it for your records.
For married/registered domestic partners (RDPs) filing jointly, only one spouse/RDP needs to sign.
Part I: Taxpayer Information
Your first name
Last name
Your SSN or ITIN
If filing jointly, spouse’s/RDP’s first name
Last name
Spouse’s/RDP’s SSN or ITIN
Address (include number and street, PO Box, or PMB no.)
Apt. no./Ste. no.
Telephone number
(
)
City
State
ZIP Code
 I elect not to e-file my tax return.
Reason (optional):_______________________________________________________________________
Your signature
Date
Spouse’s/RDP’s signature (if filing jointly)
Date
Part II: Tax Preparer Information
 I am not e-filing this taxpayer’s return due to reasonable cause.
Explanation:____________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Paid preparer’s signature
Date
Paid preparer’s name
PTIN
Firm’s name (if applicable)
FEIN
Firm’s or preparer’s address
Telephone number
(
)
City
State
ZIP Code
FTB 8454
(2012)
For Privacy Notice, get form FTB 1131.
C3

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