Form 540a - California Resident Income Tax Return - 1999 Page 2
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1
2Part I
1 State income tax refund adjustment (from Form 1040, line 10). See instructions . . . . . . . . . . . . . . . . . . . . . . 1
California
2 Unemployment compensation adjustment (from federal TeleFile Tax Record, line D; Form 1040EZ, line 3;
Income
Form 1040A, line 12; or Form 1040, line 19). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Adjustments
3
Social security benefits adjustment or tier 1 and tier 2 railroad retirement benefits adjustment. See instructions . .
3
See instructions
4 California nontaxable interest or dividend income adjustment. See instructions . . . . . . . . . . . . . . . . . . . . . . . 4
5 California IRA distributions adjustment. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 California pensions and annuities adjustment. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Total California income adjustments. Add line 1 through line 6. Enter here and on Side 1, line 13 . . . . . . . . 7
Part II
Contributions
1 Contribution to California Seniors Special Fund. See instructions . . . . . . . . . . . . . . . . . . . . . . . . .
47
1
You may make a contribution of $1 or more to the following funds:
00
2 Alzheimer’s Disease/Related Disorders Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
2
00
3 California Fund for Senior Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
49
3
00
4 Rare and Endangered Species Preservation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50
4
00
5 State Children’s Trust Fund for the Prevention of Child Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . .
51
5
00
6 California Breast Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
52
6
00
7 California Firefighters’ Memorial Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
53
7
00
8 California Public School Library Protection Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
54
8
00
9 D.A.R.E. California (Drug Abuse Resistance Education) Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55
9
00
10 California Mexican American Veterans’ Memorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56
10
00
11 Emergency Food Assistance Program Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
57
11
00
12 California Peace Officer Memorial Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
58
12
00
13 Birth Defects Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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13
14 Total contributions. Add line 1 through line 13. Enter here and on Side 1, line 34 . . . . . . . . . . . . . . . . . . . . . 14
Part III
To have your refund directly deposited, fill in the boxes below. See instructions.
Routing number
Direct Deposit
Account type:
Information
Account
Checking
Savings
number
Under penalties of perjury, I declare that I have examined this return and to the best of my knowledge and belief, it is true, correct, and complete.
9
Part IV
Your signature
Spouse’s signature (if filing joint, both must sign)
Daytime phone number
(
)
Sign Here
X
X
Date
Paid Preparer’s SSN/FEIN/PTIN
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
It is unlawful to
forge a spouse’s
signature.
Firm’s name (or yours if self-employed)
Firm’s address
Joint return?
See instructions
Where to
REFUND or NO AMOUNT DUE (Side 1, line 35):
Mail Your
FRANCHISE TAX BOARD
Return
PO BOX 942840
SACRAMENTO CA 94240-0000
AMOUNT DUE (Side 1, line 36):
•
Make your check or money order payable to “Franchise Tax Board.”
•
Write your social security number and “1999 Form 540A” on your check
FRANCHISE TAX BOARD
or money order.
PO BOX 942867
•
Attach check or money order to your Form 540A.
SACRAMENTO CA 94267-0001
Keep a copy of this signed return with your tax records for four years from the due date for filing your return.
•
•
Be sure to file your return by April 17, 2000.
Be sure to enter your social security number(s) in Step 1a.
•
•
If you cannot file your return by April 17, 2000, and
Use the preprinted label if you received one. If the information is not
owe tax, be sure to complete form FTB 3519, Payment
correct, make the necessary corrections in ink.
Voucher for Automatic Extension for Individuals, and
•
pay the amount you owe by April 17, 2000, to avoid late
Do not attach your federal return to this return.
payment penalties and interest.
Side 2 Form 540A
1999
540A99209
C1
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