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Your name:
Your SSN or ITIN:
31 AMOUNT YOU OWE. Add line 27, line 29, and line 30. See instructions. Do not send cash.
Amount
You Owe
Mail to: FRANCHISE TAX BOARD
PO BOX 942867
.
SACRAMENTO CA 94267-0001. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
,
00
Pay online – Go to ftb.ca.gov for more information.
Direct
32 REFUND OR NO AMOUNT DUE. Subtract line 30 from line 28. See instructions.
Deposit
Mail to: FRANCHISE TAX BOARD
(Refund
PO BOX 942840
Only)
.
SACRAMENTO CA 94240-0001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32
,
00
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 32) is authorized for direct deposit into the
account shown below:
Type
Routing number
Checking
Account number
33 Direct deposit amount
.
,
00
Savings
The remaining amount of my refund (line 32) is authorized for direct deposit into the account shown below:
Type
Routing number
Account number
Checking
34 Direct deposit amount
.
,
00
Savings
To learn about your privacy rights, how we may use your information, and the consequences for not providing the requested information, go to
ftb.ca.gov and search for privacy notice. To request this notice by mail, call 800.852.5711.
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the information on this tax return is true, correct, and complete.
Your signature
Date
Spouse’s/RDP’s signature (if a joint tax return, both must sign)
X
X
Your email address. Enter only one email address.
Preferred phone number
Sign
(
)
Here
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/RDP’s
Firm’s name (or yours, if self-employed)
PTIN
signature.
Joint tax return?
See instructions.
Firm’s address
FEIN
Do you want to allow another person to discuss this tax return with us? See instructions. . . .
Yes
No
Print Third Party Designee’s Name
Telephone Number
(
)
Side 4
Form 540 2EZ
2016
3114163
C1