Form 540 2ez - California Resident Income Tax Return - 2016 Page 3
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Your name:
Your SSN or ITIN:
Voluntary Contributions
Code
Amount
.
California Seniors Special Fund. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
400
00
.
Alzheimer’s Disease/Related Disorders Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
401
00
.
Rare and Endangered Species Preservation Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
403
00
.
California Breast Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
405
00
.
California Firefighters’ Memorial Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
406
00
.
Emergency Food for Families Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
407
00
.
California Peace Officer Memorial Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
408
00
.
California Sea Otter Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
410
00
.
California Cancer Research Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
413
00
.
RESERVED (DO NOT USE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
School Supplies for Homeless Children Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
422
00
.
State Parks Protection Fund/Parks Pass Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
423
00
.
Protect Our Coast and Oceans Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
424
00
.
Keep Arts in Schools Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
425
00
.
State Children’s Trust Fund for the Prevention of Child Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . .
430
00
.
Prevention of Animal Homelessness and Cruelty Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
431
00
.
Revive the Salton Sea Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
432
00
.
California Domestic Violence Victims Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
433
00
.
Special Olympics Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
434
00
.
Type 1 Diabetes Research Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
435
00
.
30 Add amounts in code 400 through code 435. These are your total contributions . . . . . . . . . . . . . .
30
00
3113163
Side 3
Form 540 2EZ C1 2016 (REV 03-17)
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