TAXABLE YEAR
FORM
2016
California Resident Income Tax Return
540
Fiscal year filers only: Enter month of year end: month________ year 2017.
Your first name
Initial Last name
Suffix
Your SSN or ITIN
A
If joint tax return, spouse’s/RDP’s first name
Initial Last name
Suffix
Spouse’s/RDP’s SSN or ITIN
R
Additional information (see instructions)
PBA code
RP
Street address (number and street) or PO box
Apt. no/ste. no.
PMB/private mailbox
City (If you have a foreign address, see instructions)
State
ZIP code
Foreign country name
Foreign province/state/county
Foreign postal code
Your DOB (mm/dd/yyyy)
Spouse's/RDP's DOB (mm/dd/yyyy)
If you filed your 2015 tax return under a different last name, write the last name only from the 2015 tax return.
Taxpayer
Spouse/RDP
1
Single
4
Head of household (with qualifying person). See instructions.
2
Married/RDP filing jointly. See inst.
5
Qualifying widow(er) with dependent child. Enter year spouse/RDP died
3
Married/RDP filing separately. Enter spouse’s/RDP’s SSN or ITIN above and full name here
If your California filing status is different from your federal filing status, check the box here . . . . . . . . . . . . . .
6
If someone can claim you (or your spouse/RDP) as a dependent, check the box here. See inst . . . . . . .
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
7 Personal: If you checked box 1, 3, or 4 above, enter 1 in the box. If you checked
X $111 =
box 2 or 5, enter 2, in the box. If you checked the box on line 6, see instructions . .
7
$
8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1;
X $111 =
if both are visually impaired, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
$
9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1;
X $111 =
if both are 65 or older, enter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
$
10 Dependents: Do not include yourself or your spouse/RDP.
Dependent 1
Dependent 2
Dependent 3
First Name
Last Name
SSN
Dependent's
relationship
to you
X $344 =
10
$
Total dependent exemptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32 . . . . . . . . . . . . . . . . . . . . .
11
$
Form 540
2016 Side 1
3101163
C1