Form 540 C1 - Draft - California Resident Income Tax Return - 2012
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5For Privacy Notice, get form FTB 1131.
FORM
California Resident Income Tax Return 2012
540
C1 Side 1
Fiscal year filers only: Enter month of year end: month________ year 2013.
Your first name
Initial Last name
Your SSN or ITIN
P
AC
If joint tax return, spouse's/RDP's first name
Initial Last name
Spouse's/RDP's SSN or ITIN
A
Address (number and street or PO Box)
Apt. no/Ste. no.
PMB/Private Mailbox
R
Address (number and street or PO Box)
PBA Code
City (If you have a foreign address, see page 7)
State
ZIP Code
RP
Foreign Country Name
Foreign Province/County
Foreign Postal Code
Your DOB (mm/dd/yyyy)
Spouse's/RDP's DOB (mm/dd/yyyy)
If you filed your 2011 tax return under a different last name, write the last name only from the 2011 tax return.
Taxpayer
Spouse/RDP
m
m
1
Single
4
Head of household (with qualifying person) (see page 3)
m
m
2
Married/RDP filing jointly (see page 3)
5
Qualifying widow(er) with dependent child. Enter year spouse/RDP died
m
3
Married/RDP filing separately. Enter spouse’s/RDP’s SSN or ITIN above and full name here
m
If your California filing status is different from your federal filing status, check the box here . . . . . . . . . .
m
6 If someone can claim you (or your spouse/RDP) as a dependent, check the box here (see page 7) . . . . .
6
For line 7, line 8, line 9, and line 10: Multiply the amount you enter in the box by the pre-printed dollar amount for that line.
Whole dollars only
m
7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked
X $104 =
$
box 2 or 5, enter 2, in the box. If you checked the box on line 6, see page 7 . . . . . . . 7
m
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;
X $104 =
$
if both are visually impaired, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
m
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1;
X $104 =
$
if both are 65 or older, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Dependents: Do not include yourself or your spouse/RDP.
First name
Last name
Dependent's relationship to you
m
X $321 =
$
Total dependent exemptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
$
11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32 . . . . . . . . . . . . . . . . . . .
11
3101123
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