Form 540 2ez - California Resident Income Tax Return - 2004 Page 2

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Your name _____________________________ Your SSN or ITIN: _________________________
Step 5a
0 0
¼ ¼ ¼ ¼ ¼
. . . . .
22
Use tax. This is not a total line. See instructions, page 8 . . . . . . . . . . . . . . .
22
,
Use Tax
Step 6
Voluntary Contributions. See instructions, page 9 . . . . . . . . . . . . . . . . . . . . . . . . . . Code
Amount
Contributions
¼ ¼ ¼ ¼ ¼
00
California Seniors Special Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
52
_______________
¼ ¼ ¼ ¼ ¼
00
Alzheimer’s Disease/Related Disorders Fund . . . . . . . . . . . . . . . . . . .
53
_______________
¼ ¼ ¼ ¼ ¼
00
California Fund for Senior Citizens . . . . . . . . . . . . . . . . . . . . . . . . . . .
54
_______________
¼ ¼ ¼ ¼ ¼
00
Rare and Endangered Species Preservation Program . . . . . . . . . . . .
55
_______________
¼ ¼ ¼ ¼ ¼
00
State Children’s Trust Fund for the Prevention of Child Abuse . . . . . .
56
_______________
¼ ¼ ¼ ¼ ¼
00
California Breast Cancer Research Fund . . . . . . . . . . . . . . . . . . . . . .
57
_______________
¼ ¼ ¼ ¼ ¼
00
California Firefighters’ Memorial Fund . . . . . . . . . . . . . . . . . . . . . . . . .
58
_______________
¼ ¼ ¼ ¼ ¼
00
Emergency Food Assistance Program Fund . . . . . . . . . . . . . . . . . . . .
59
_______________
¼ ¼ ¼ ¼ ¼
00
California Peace Officer Memorial Foundation Fund . . . . . . . . . . . . .
60
_______________
¼ ¼ ¼ ¼ ¼
00
Asthma and Lung Disease Research Fund . . . . . . . . . . . . . . . . . . . .
61
_______________
¼ ¼ ¼ ¼ ¼
00
California Missions Foundation Fund . . . . . . . . . . . . . . . . . . . . . . . . .
62
_______________
¼ ¼ ¼ ¼ ¼
00
California Military Family Relief Fund . . . . . . . . . . . . . . . . . . . . . . . . .
63
_______________
¼ ¼ ¼ ¼ ¼
00
California Prostate Cancer Research Fund . . . . . . . . . . . . . . . . . . . .
64
_______________
¼ ¼ ¼ ¼ ¼
. . . . .
23 Add line 52 through line 64. These are your total contributions . . . . . . . . . . . . . . .
23
,
Step 7
24 REFUND or NO AMOUNT DUE. Subtract line 22 and line 23 from line 20. If line 20
is less than line 22 and line 23, enter the difference on line 25.
Refund or
Amount You
See instructions, page 9. Mail to:
Owe
FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0002. . . . .
24
. . . . .
,
25 AMOUNT YOU OWE. Add line 21, line 22, and line 23.
See instructions, page 9. Mail to:
. . . . .
FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001 . . . .
25
,
Or, pay online with FTB’s Web Pay – Go to our Website at
Get Your Refund Faster with Direct Deposit
Do not attach a voided check or a deposit slip. See instructions, page 12.
Direct
¼ ¼ ¼ ¼ ¼
Fill in the boxes to have your refund directly deposited. Routing number . . .
Deposit
(Refund Only)
¼ ¼ ¼ ¼ ¼
¼ ¼ ¼ ¼ ¼
Account Type:
Checking
Savings
¼ ¼ ¼ ¼ ¼
Account number . . . . . . . . . . . . .
Under penalties of perjury, I declare that, to the best of my knowledge and belief, the information on this return is true, correct, and
complete.
3
Step 8
Your signature
Spouse’s signature (if filing jointly, both must sign)
Daytime phone number (optional)
)
(
Sign Here
X
X
Date
It is unlawful to
Paid Preparer’s SSN/PTIN
Paid preparer’s signature (declaration of preparer is based on all information of which preparer has any knowledge)
forge a spouse’s
¼
signature.
Firm’s name (or yours if self-employed)
Firm’s address
FEIN
Joint return?
¼
See instructions,
page 9.
Please note, do not attach a copy of your federal tax return to Form 540 2EZ.
Side 2 Form 540 2EZ
2004
2EZ04203
C1

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